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Liver Disease

We know that you, your loved ones, friends or employees lives may have been or will be touched by liver disease.

Here are the facts you need to know:

Liver Disease in the United States

  • 25,000,000 Americans – one in every 12 – are or have been afflicted with liver, biliary or gallbladder disease.
  • 20,300 Americans die each year from chronic liver disease and cirrhosis; 60,000 people are hospitalized each year due to cirrhosis.
  • Alcoholic liver disease and chronic hepatitis C are the leading causes of cirrhosis.
  • Approximately 6,000 liver transplants are performed yearly in the US. Because of the shortage of organs, it is estimated that over 1,800 people die per year while waiting for a liver transplant. There are currently over 17,700 people waiting for a liver for transplantation.
  • Hepatitis A and B are preventable by vaccination


For more liver disease information, please visit the Saint Louis University Liver Center site.

Types of Liver Disease

  • Common cause of chronic liver disease leading to cirrhosis, liver failure
  • More than 3-4 drinks per day for 15 to 20 years can lead to cirrhosis
  • Liver function can recover with abstinence
  • Liver function can improve with abstinence even after cirrhosis has developed
  • Liver transplant available for those who have stopped drinking and remain sober
  • Is an uncommon, genetic condition that causes the liver to retain alpha-1 antitrypsin
  • Can be diagnosed by a doctor’s physical exam and blood test. Liver biopsy or ultrasound may be ordered
  • Can present and cause liver problems in infants, children or adults
  • Liver may be gradually damaged and scarred and may progress to cirrhosis, liver failure
  • Transplant is curative


Signs & Symptoms:

  • In babies, symptoms include jaundice (eyes and skin turning yellow) swelling of the abdomen, and poor growth
  • Older children and adults may experience the above and may report feeling weak and tired
  • Most children and adults with alpha-1 have no symptoms of liver disease at all


Treatment and Follow-up:
Although there is no cure for Alpha-1, there are ways to prevent or reduce health problems related to Alpha-1. People with Alpha-1 should do the following:

  • Get hepatitis A and B vaccinations
  • Get regular exams by a doctor
  • Get regular medical tests as suggested by their doctors, such as blood tests and liver ultrasound or X-ray tests – for example, liver CT (CAT) scans
  • Stay away from tobacco smoke and heavy air pollution
  • Avoid drinking alcohol
    eat a balanced diet and maintain a healthy weight
  • Speak to your doctor before using any herbal, vitamin or other therapies
  • Most common inherited disease in Caucasians
  • Genetic susceptibility is 1 in 250 in people with a European genetic background
  • Caused by an inappropriate increase in iron absorption leading to iron deposition in the liver and other organs
  • SLULC investigators were directly involved in gene discovery published in 1996
  • Easily treated by frequent blood donations
  • Important to detect early to start treatment before liver damage occurs which can typically start by age 40 in men and age 60 in women
  • Worldwide, approximately 254,000,000 people have chronic hepatitis B virus infection
  • HBV causes 1,100,000 deaths annually
  • Worldwide, hepatitis B virus is most commonly transmitted from mother to child at time of childbirth
  • Worldwide, hepatitis B is the largest cause of hepatocellular (liver) cancer
  • 13,000 people are newly infected with the hepatitis B virus each year in the USA
  • There are about 1.4 million people chronically infected with hepatitis B virus in the USA
  • About one out of every 250 people is a carrier of hepatitis B in the US and can pass it on to others, often unknowingly
  • Hepatitis B causes 1,700 deaths annually in the USA
  • Due to the screening of pregnant women for hepatitis B and vaccinations of newborns, there has been a sharp decline in the number of newborns infected at the time of childbirth
  • The estimated medical and work loss cost per year from hepatitis B is over $1 billion in the USA
  • Asian-Americans have the highest rate of chronic hepatitis B in the USA
  • A very safe and effective vaccine is available and is now given to all infants
  • Safe and affordable antiviral therapies are available given as a pill once daily to help keep the virus from causing liver damage and cirrhosis


You are at risk of hepatitis B infection if you:

  • Come in contact with blood from someone who is infected with hepatitis B virus
  • Have unprotected sex with someone who is infected with hepatitis B (same or opposite sex)
  • Have a job that involves contact with human blood (e.g., nurse, emergency medical technician)
  • Inject illegal drugs
  • There are over 4 million people in the US who are infected with the hepatitis C virus. Approximately 50% to 70% of people infected do not know that they have this infection.
  • It is estimated that there are over 130,000 people in the State of Missouri who have hepatitis C. The majority of these patients live in the St. Louis Metropolitan area (about 45,000) and in the Kansas City Metropolitan area.
  • Hepatitis C is 5 times more prevalent than HIV/AIDS
  • An estimated 25,000 people are newly infected with hepatitis C each year in the US and this number is increasing due to increased heroin use
  • 10,000 – 12,000 people die of complications from hepatitis C each year in the US; the Centers for Disease Control and Prevention (CDC) estimates that the number of deaths from hepatitis C will triple in the next 10 – 20 years
  • The estimated medical and work loss costs per year from hepatitis C is over $1 billion in the US
  • African-Americans have the highest rate of infection with hepatitis C in the US


You are at risk of hepatitis C infection if you:

  • Have ever injected or inhaled illegal drugs, even if you only experimented once many years ago
  • Partners received a blood transfusion or solid organ transplant before July 1992
  • Received a blood product for clotting problems produced before 1987
  • Have ever been on long-term kidney dialysis
  • Have received a tattoo or body piercing in unsafe conditions
  • Have unprotected sex with multiple partners


Treatment:

  • Nearly all people with hepatitis C can be cured with oral medications (pills) for 8-12 weeks.
  • Liver transplant is rarely needed any more for hepatitis C cirrhosis because the available treatments are so effective in eliminating the infection.
  • Many medications can cause liver enzyme elevations, chronic hepatitis, cirrhosis, or acute liver failure
  • Acetaminophen (Tylenol) is a common cause of drug-induced liver injury
  • Cholesterol lowering medications (“statins”) cause elevated liver tests in 4% of people but this is rarely associated with significant liver damage
  • Antibiotics, anti-seizure medications are also common causes
  • Onset can be immediately after starting a new medication or after many months of taking a medication
  • Mostly reversible when recognized early
  • Herbal remedies and dietary supplements are also known to cause liver damage, especially body building and weight loss supplements

New Names

  • The names for fatty liver diseases were changed in 2022.
  • What was once called “NASH” (nonalcoholic steatohepatitis) in now called “MASH” (metabolic dysfunction-associated steatohepatitis, note the D for dysfunction is dropped from the acronym).
  • What was once called “NAFLD” (nonalcoholic fatty liver disease is now called MASLD (metabolic dysfunction-associated steatotic liver disease). MASLD is an umbrella term that includes MASH and also fat accumulation in the liver with much active cell damage (MASL, metabolic dysfunction-associated steatotic liver).
  • Steatotic liver disease (SLD) is when excess fat is in the liver from any cause.
  • MetALD is a new term that is used to describe the liver disease in people with one or more metabolic risk factors (obesity, type 2 diabetes, elevated waist circumference, high blood pressure, elevated lipid levels in the blood) and they drink too much alcohol (2 or more drinks per day in women and 3 or more drinks per day in men).

MASLD

  • MASLD is a condition in which excess fat builds up in the liver in people who drink little or no alcohol (excess alcohol consumption is another reason for fat accumulation in the liver) and have one or more metabolic disease risk factors (obesity, type 2 diabetes, elevated waist circumference, high blood pressure, elevated lipid levels in the blood).
  • Between 30 and 40 percent of adults in the United States have MASLD.
  • MASLD is the most common form of chronic liver disease in U.S. in adults and children.
  • The primary way to reverse MASLD is to focus on healthy eating habits and exercise regularly.
  • The Mediterranean diet is a good dietary approach.
  • Avoiding excess sugar is very important. This means avoiding all sugar-sweetened drinks (sodas, sweet tea). The liver converts that sugar into fat which which damages the liver.

MASH

  • MASH is a sub-category of MASLD that has traditionally been diagnosed by having a liver biopsy although newer blood tests are being evaluated to replace liver biopsy.
  • MASH affects as many as 12 percent of U.S. adults or 30 million Americans (NIH).
  • If you have MASH, you have inflammation and liver cell damage, along with fat in your liver. Inflammation and liver cell damage can cause fibrosis, or scarring, of the liver. As fibrosis accumulates in the liver, it can lead to cirrhosis and liver cancer.
  • Progression is usually slow over many years to decades although some children with obesity, sedentary lifestyle and poor dietary habits can progress to MASH and even cirrhosis in their teens.
  • The primary treatment is to focus on healthy eating habits and exercise regularly.
  • The Mediterranean diet is a good dietary approach.
  • A new treatment (Rezdiffra®) was approved in the U.S. in 2023 for people with MASH and stage 2 or 3 liver fibrosis.
  • Many other treatments are being investigated in clinical trials with encouraging results. Approvals for newer medications may be announced in 2027-2030.
  • As of 2024, MASH and alcohol are the most common reasons for liver transplantation in adults.
  • Uncommon disorder affecting the tiniest bile ducts in the liver
  • Can progress to cirrhosis but often diagnosed early and thus the name of the disease does not mean that a person with PBC has cirrhosis
  • Common symptoms are feeling more tired than usual and itching
  • Common blood test called alkaline phosphatase is often elevated
  • Affects women much more often than men, typically middle aged
    Usually responds well to a medication called ursodiol
  • Can progress to cirrhosis if untreated
  • Liver transplant is an option if PBC has progressed to cirrhosis
  • Uncommon disorder affecting the large and middle-sized bile ducts with scarring
  • Chronic blockage of bile ducts by scarring leads to liver damage
  • Can progress to cirrhosis, liver failure and bile duct cancer
  • Affects men more than women
  • Cause unknown – may be immune-mediated
  • Often associated with ulcerative colitis
  • No effective treatment other than liver transplant
  • Rare, inherited disorder of copper metabolism leading to copper accumulation in the liver
  • Usually patients present as adolescents or young adults
  • Can cause variable neurological changes such as behavioral changes and tremors
  • Can result in cirrhosis or acute liver failure
  • Treatment with copper-binding agents is life-saving and successful

One of the main objectives of the Saint Louis University Liver Center is to apply new technologies discovered by basic science and clinical research to the medical care of patients with liver disease.

Expertise in the field of liver disease research by the renowned SLU Liver Center physician investigators, is the catalyst which attracts pharmaceutical industries to desire that Saint Louis University participate in their clinical trials. Because of this, it’s important to note that the Division of Gastroenterology and Hepatology alone, does over 1/3 of all clinical trials that are conducted at Saint Louis University. The SLU Liver Center participates in many multi-center studies of new medications to see if they might be effective for the treatment of hepatitis B, hepatitis C, nonalcoholic steatohepatitis (NASH), primary biliary cholangitis (PBC) and other forms of liver disease.

Conducting these trials in a safe and efficient manner is critical to their success. Maintaining the integrity of clinical trials and the safety of enrolled patients is paramount and there isn’t a better team of individuals to do this than the clinical trials research staff in the GI and Hepatology Clinical Trial Units at SLU.

If you have liver disease and would like to know if the Liver Center currently has a trial that you might be interested in hearing more about, call the clinical trials unit at 314-977-9400. There is no obligation by calling.