"Only 2% of the resources of research in hepatology are allocated to diseases of alcoholic origin," assured Dr. Ramon Batallerresearcher of the University of North Carolina and of the Bowles Center for programs of study on Alcoholduring the lecture he gave at the Centre for Applied Medical Research (CIMA) of the University of Navarra. Dr. Bataller's group collaborates with the Hepatology Program of the CIMA in the study of the mechanisms of liver disease.

There are two major groups of liver diseases: those caused by viruses and fatty liver disease. "In viral pathologies, much progress has been made: there are vaccines and oral treatments for hepatitis B and the latest oral treatments for the C virus are one of the most important advances in medicine, although they are very expensive and are currently a source of social conflict.

On the other hand, fatty liver disease is the subject pending issue for hepatology specialists. According to researcher, "this disease is caused by metabolic syndrome (obesity, diabetes...) or by alcohol abuse and is the most important cause of serious liver disease, such as alcoholic cirrhosis. The only treatment C is to treat the cause, i.e. to lose weight or stop drinking. This requires multidisciplinary teams of doctors, psychologists and dieticians working together to promote healthy lifestyle habits in patients.

Another problem hepatologists encounter is the stigma associated with alcohol disease. "The advertising about alcohol is misleading, and many times it is linked to success in sports and social relationships, etc. But abusive consumption leads to the marginalization of the patient, especially because it is a self-inflicted pathology, and when they go to enquiry it is usually in advanced stages of the disease."

Early detection

Dr. Bataller alerted during his visit to CIMA of the need to establish early detection measures for alcoholic liver disease. "The symptoms (yellow skin, abdominal distension...) manifest themselves when the disease has progressed to advanced cirrhosis. That is why it is essential to develop programs both in primary care services and in addiction groups to find out if a person who drinks excessively already has incipient liver disease".

Once it progresses to its most severe form, alcoholic hepatitis, the treatment is the same as in 1971, corticosteroids. With the goal to develop new therapies, the research in the United States is focusing on finding out which molecules cause liver failure in a person who has consumed alcohol. "Until now, alcoholic hepatitis was thought to be just an inflammation of the liver, so treatments were aimed at reducing the inflammation. However, the inflammatory process is core topic for the defenses, so if you eliminate the inflammation you expose the sufferer to serious infections. Now it is known that there is a failure of the liver cells, the hepatocytes, so research is based on how to modulate the 'bad' inflammation and to look for measures to regenerate the liver," explains Dr. Bataller.

One of the recent developments is based on the selection of the patient candidate for transplantation. "Traditionally, an alcoholic could not be transplanted if he or she had not been abstinent for six months. However, a European study led by Dr. Mathurin has shown that in many patients the development of alcoholic hepatitis is the first symptom of liver disease. In severe cases, the mortality of this disease is almost 50% at three months, so patients cannot wait 6 months for transplantation. In this study, early liver transplantation was performed in very selected patients and many lives were saved, many times in young patients. It is important to emphasize that the majority of patients did not return to drinking. This measure has become an alternative that is now slowly being introduced in most countries," says researcher of the University of North Carolina.