Fatty Liver

 

Non-alcoholic fatty liver disease (NAFLD) is defined as the accumulation of liver fat (steatosis) in the absence of causes such as alcohol, medications and genetic conditions.   It is really a spectrum of diseases from simple steatosis without inflammation or liver injury, through to non-alcoholic steato-hepatitis (NASH), a condition with steatosis, inflammation and usually some degree of fibrosis. In Western societies NAFLD / NASH is more prevalent than other forms of hepatitis and may be present in up to 40% of the adult population.   In Australia it is projected that by 2030 7.3million people will have fatty liver disease.

Most people with NAFLD are asymptomatic and rely on imaging to diagnosis the condition. Liver enzymes often fluctuate but do not reflect the degree of underlying liver injury and even those with normal liver enzymes may have underlying fibrosis.  Those with NAFLD usually have a 30% chance of developing NASH and a < 10% chance they develop liver cirrhosis. However NAFLD has a strong association with central obesity and insulin resistance and is a significant risk factor for the development of metabolic disorders including hypertension, dyslipidaemia and cardiovascular disease.  Those with NAFLD have up to 3 times the average risk of developing diabetes.

There are no approved medical therapies for NAFLD with treatment focusing on weight loss.  A reduction of 5 – 10% of body weight has been shown to improve liver histology.  Many alternative therapies have been tried, with some evidence for vitamin E in a small subset of patients (fibrosis did not improve).  Emerging evidence suggests those who drink coffee have less liver fibrosis and steatosis than non-coffee drinkers.  There are new therapies on the horizon but these are currently in clinical trials.

Iron Deficiency

IRON DEFICIENCY ANAEMIA (IDA) 

Management of iron deficiency is a common clinical problem faced by both gastroenterologists and general practitioners and may signal the presence of un-suspected digestive disease. 

1. Data from large studies indicates iron deficiency with accompanying anaemia is present in 1-3% of the adult population.
2. Iron deficiency without anaemia is more common and seen in up to 11% of women (usually premenopausal) and 4% of men.
3. It is estimated that up to 15% of Australians older than 65 have IDA.

Gastroscopy and colonoscopy as combined investigations are mandatory in the evaluation of IDA. Sometimes, patients are only referred for one procedure which draws out the investigation and is more costly. Speak to your specialist or GP if you suspect that you have IDA. 

If you are a medical professional review our article on IDA here.

Irritable Bowel Syndrome (IBS)

Irritable bowel syndrome (IBS) is a condition characterised by abdominal pain and altered bowel habit without abnormalities on radiological, endoscopic or laboratory investigation. 

Several subgroups of IBS can be recognised on the basis of symptoms and may be classified as:

• constipation predominant,
• diarrhoea predominant or
• mixed.

IBS symptoms are very common occurring in up to 15% of the general population. 

• Less than 20% however tend to seek medical advice for their symptoms. 
• It is twice as common in females as males and
• Half of the individuals who present with IBS are younger than 35 years of age. 

It has been reported that approximately 30% of IBS sufferers take sick leave with half of these being absent from work at least two weeks per year.

Speak to your doctor or specialist if you are suffering from more than one of the following symptoms:

1. Frequent defecation with abdominal pain.
2. Relief of pain by defecation.
3. Loose motion with onset of abdominal pain.
4. Per rectal passage of mucus
5. Sensation of incomplete evacuation of bowels
6. Abdominal bloating