Frequently Asked Questions (FAQs) related to bowel and liver diseases in Sri Lanka

Why does everyone have 'gastritis'?

Symptoms of pain or 'burning sensation' in the upper abdomen or abdominal fullness after meals or early satiation are expected in up to 30-50 % of the population worldwide. However, these are common symptoms and do not necessarily mean an upper gastrointestinal endoscopy (UGIE) is needed.

However, patients who also have 'sinister' symptoms of persistent loss of appetite, unintentional weight loss, difficulty swallowing food, recurrent vomiting, evidence of blood loss or anaemia etc., need UGIE to look for an underlying sinister cause.

Alternatively, stress or even depression may present with similar 'gastritis' symptoms and should be addressed accordingly and may not resolve entirely within addressing these psychological issues.

Screening for large bowel carcinoma?

Colorectal or large bowel carcinoma (CRC) is the third most common cancer worldwide. CRC start as a polyp (small fleshy growth in the colon). If detected early and removed, polyps can be prevented from becoming CRC.

Some countries screen asymptomatic (those without symptoms) adults (45-75 years) by testing the stools for blood (stool for occult blood on three consecutive days) to detect patients who are more likely to have colonic polyps or early CRC. These patients with positive stool occult blood are invited for screening colonoscopy to detect and treat polyps.

The presence of persistent loss of appetite, unintentional weight loss coupled with a change in bowel habits or passage of blood in their stools may be suggestive of CRC. Therefore, if someone has these symptoms, they should be investigated with a colonoscopy, especially as one grows older.

What's fatty liver disease, and what does it mean if found in my scan.

Foods rich in calories, unhealthy fats and sugars are becoming more common in Sri Lanka. More people are adopting a sedentary lifestyle with reduced day-to-day physical activity. When we consume more calories than we use in our daily activities, our bodies save them up and store them as fat. Not only do we gain weight and become fatter, but the excess fat also gets deposited in our livers, which is called 'non-alcoholic fatty liver disease.

Fatty liver disease may be detected incidentally when an abdominal scan is done for another reason or on routine blood tests with elevated liver enzymes.

Usually, the fatty liver disease does not cause any symptoms. However, fatty liver disease is commonly associated with obesity, diabetes, high blood pressure and abnormal blood lipids. Therefore, if not detected and left untreated, fatty liver disease can lead to cardiovascular complications (heart attacks and stroke), liver cirrhosis, and liver cancer.

Do all patients with fatty liver lead to cirrhosis long term?

Not everyone who has fatty liver will progress to develop cirrhosis. The majority will not move to cirrhosis. However, a minority may progress to cirrhosis slowly, usually over decades.

The risk of progression to cirrhosis in higher among those with liver fibrosis (scarring of the liver). This risk may be greater with age, obesity or increased weight, poorly controlled diabetes, hypertension, high cholesterol and a family history of cirrhosis and associated alcohol consumption.

Controlling these factors, losing weight through regular physical exercise and maintaining a diet low in calories longterm can reduce or prevent someone with fatty liver from progressing to cirrhosis.

Can taking diabetic drugs for a long period cause cirrhosis?

No, this is a myth. Drugs prescribed for diabetes, hypertension or high cholesterol never cause cirrhosis. It is quite the opposite. These drugs, by helping to control the disease, hypertension or high cholesterol, will help prevent the development of cardiovascular complications (heart attacks and stroke) related to fatty liver disease.

What is cirrhosis of the liver?

Cirrhosis is a common term referring to permanent liver damage in the presence of long-term liver injury. However, the extent of the damage and manifestations is variable. Those with early cirrhosis may not have symptoms or complications for a long time. Those who have advanced cirrhosis have a worse outcome and ideally need a liver transplant.

Is cirrhosis always due to alcohol?

Although long-term, unsafe alcohol intake may lead to cirrhosis, over half of the patients with cirrhosis in Sri Lanka have "non-alcoholic" cirrhosis. These patients have either not consumed any alcohol or consumed only occasional safe amounts. Many of these patients have a long history of obesity, diabetes, hypertension and high cholesterol and likely have cirrhosis related to non-alcoholic fatty liver disease. In addition, rare genetic conditions, autoimmune conditions of the liver and chronic viral hepatitis (hepatitis B & C) may also cause cirrhosis, so cirrhosis is not always due to alcohol!

I'm taking alcohol regularly - Can I have cirrhosis?

If you have any concerns, a routine abdominal ultrasound scan can check if you do or do not have cirrhosis. Otherwise, you can even do a simple blood test - complete blood count (CBC) and liver enzymes (ALT and AST) so the doctor can calculate the risk of having significant liver fibrosis (early cirrhosis). Those with abnormal values on this calculation (FIB-4 score) will need a special liver scan (FibroScan) to detect and estimate liver stiffness. A FibroScan accurately "rule in" or "rule out" significant liver fibrosis and see those with advanced liver fibrosis or early cirrhosis.

If someone has cirrhosis, do they have to abstain from alcohol completely?

If you or a loved one has cirrhosis, it is essential that they completely stop taking any alcohol. In cirrhosis, any alcohol consumption quickly causes liver disease progression.

Do all patients with cirrhosis need liver transplants?

Patients with early cirrhosis do not need a transplant. However, there is a tendency for liver fibrosis to progress gradually over a while. It is difficult to predict this; in some patients, the disease may remain very stable for a long time.

However, suppose the liver damage has progressed to advances stages with the development of symptoms (yellow discoloration of eyes, swelling of the abdominal and ankles) complications of cirrhosis (vomiting of blood, passage of dark tarry stools, excessive drowsiness, confusion or episodes of unconsciousness or early liver cancer). In that case, a liver transplant is the only treatment that will cure the disease.

Liver transplant and Organ Donation

A liver transplant is a complex and demanding surgery that can be selectively offered to suitable patients. After successful transplantation, such selected patients can live a 'near normal' life.

There are two sources of organs for transplantation. The liver can be received from a brain death donor such as those after a massive brain injury after a road traffic collision, where there is absolutely no possibility of recovery, but where in such situations the patient was connected to a breathing machine or "ventilator" and as a result, their organs such as their liver, were in good condition. Donation of such organs by the brain-dead person's family can potentially save the life of a patient who is waiting for transplantation and has no hope of otherwise surviving. Worldwide there is a huge shortage of such organs as there will usually be more patients who need a transplant, and only a few organs available for transplant. Hence, good public awareness to help promote organ donation is vital for a country to have a successful transplant program.

Alternatively, part of the liver can be donated from a living donor as around two-thirds of a healthy liver can be donated, and the remaining liver can "grow back" relatively soon. This is commonly practised in pediatric patients with cirrhosis, where their mother or father may donate part of their liver. Donations of such organs by living donors should always be made purely with altruistic intentions without any financial interests etc.