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Doctors at Hunter Holmes McGuire VA Medical Center are pioneering a program aimed at treating an emerging liver disease that affects up to a third of Americans.
The program targets nonalcoholic fatty liver disease — fat deposited in the liver by causes other than alcohol consumption — and a more severe form of the disease, nonalcoholic steatohepatitis (NASH), which can lead to cardiovascular disease, stroke or liver cancer if left untreated, according to Michael Fuchs, chief of hepatology at McGuire.
Nonalcoholic fatty liver disease and NASH are linked with health issues including diabetes and obesity, and most people at risk are unaware of the condition. Fuchs suggests that the more severe form will one day become the leading cause of liver transplants. “It’s really a silent disease; [there are] no specific symptoms,” he says.
The best treatment is through weight loss. “If a patient loses 10 percent or even more of their body weight, the disease can almost entirely regress,” Fuchs says.
However, motivating patients to lose weight isn’t always a viable option if a patient is dealing with other health concerns such as injuries or mental health issues. To that end, McGuire announced Monday that it has created a program that seeks to improve the condition holistically. The program utilizes all the medical professionals at McGuire to treat patients rather than just individual specialists, according to HoChong Gilles, a McGuire nurse practitioner.
Each patient is given a personalized approach to treating their condition. Gilles calls this a "patient-centered" approach. “You have to look what they’re eating, what their resources are,” she sayss. “Obviously a lot of them need health coaching, but we also have to look at their behavior.”
McGuire screens all its patients for liver disease rather than just those who are at risk, according to Gilles. The program follows an effort begun in 2015 to eliminate cases of Hepatitis C among the hospital's patients. That program has had a cure rate of 96 percent in the 1,120 veterans who have been treated, according to McGuire. The Hepatitis C campaign was initiated after the facility received funding and new treatments became available that were more effective and had fewer severe side effects.
The new program targeting nonalcoholic fatty liver disease is in its pilot stage, with 40 patients enrolled. Half are being actively treated.
Richard C. Smith, a 70-year-old Army veteran, says he had no symptoms before he was screened and diagnosed. Now, he’s being monitored by doctors and is on a treatment regimen than includes dietary restrictions, exercise and medication currently being tested by the FDA to treat liver disease.
“We’re trying to say ahead of this disease instead of being reactive like we usually do,” said Gilles.
Treatment may need to be lifelong, since lifestyle factors such as diet and exercise are frequently involved. But that’s a positive to Gilles, who notes that data shows that patients who visit their doctors frequently see more improvement in their health than those who go for one-time treatments.
Fuchs says that the McGuire program also has a goal to spread awareness and advocacy in the medical world regarding the disease. He notes that there are few similar programs across the nation, and that he hopes the McGuire program inspires other VA facilities and private practice doctors and facilities to develop similar programs.