SMMGP - Substance Misuse Management Good Practice

Substance Misuse Management Good Practice

Supporting good practice in drug and alcohol treatment

Post-its from Practice:
Fatty liver - Eat, drink and be wary (Nov 2009)

Not a benign disease and an increasing condition of the middle aged

I have known Mrs Brown for over twenty years, having been her GP through her children's illnesses, the collapse of her first marriage and her delight in meeting the love of her life in her forties. She rarely visited me for her own health reasons until her acrimonious divorce, which resulted in high anxiety and insomnia. She had always liked a drink but the amount she consumed increased during that period. However much we talked about it, she remained convinced that alcohol helped. Her food consumption also increased during that time but she decided she would address both when the divorce was over.

But of course that didn't happen, and she continued to eat and drink when she was happy. She declined counselling, suggestions to try AA and other self-help groups and her weight continued to increase. After a break of about six months she came to see me, concerned about the weight she had put on around her middle. Her friends had also began asking her when the baby was due - at the age of 59!

Examination showed not only further weight gain, but a swollen liver as well. I asked her again about her drinking and she admitted to half a bottle of vodka three or four times per week, equivalent to 45-60 units/week along with cakes and chocolate bars daily. I suspected fatty liver disease which was confirmed on ultrasound.

Fatty liver disease is not a benign condition and is can be caused by either drinking or obesity or both. It is fuelling the liver disease crisis among middle aged people in the UK. The average age of those dying of liver disease has fallen to 60 for women and 58 for men - four years lower for both sexes than 25 years ago. Liver disease is the only major cause of death that is increasing year on year, with the rate doubling in the last decade. It is already the fifth biggest killer, after cancer, respiratory disease, heart disease and stroke - and it is set to overtake the latter two in as little as two years. It is also a much bigger threat to people in middle age, compared with heart disease and stroke, where the average ages of death are currently 82 and 84 respectively.

It is widely known that the Department of Health is so concerned that they have appointed a liver disease "tsar" to introduce a national strategy to combat the crisis. The tsar will decide whether to support liver screening blood tests for all over40s and a call for more specialist liver doctors.

The impact of alcohol intake on the liver is well-known. Last year, 105 people a day were admitted to hospital with a primary or secondary diagnosis of alcoholic liver disease, but, many do not realise that obesity is increasingly a cause of liver disease. As many as one in five people now have evidence of non-alcoholic "fatty liver" disease. More than half a million people in England could end up with obesity-related cirrhosis of the liver, with many of today's obese adults dying in their 60s and 70s with liver failure.

Mrs Brown has managed to stop drinking and her liver function tests have improved but her weight continues to rise. As such, the risk remains of her dying due to liver disease.

- Dr Chris Ford