On the hunt for chronic liver diseases

His dream came true. Committed for decades to the fight against hepatitis C, Dr Denis Ouzan, president of RHECCA (Hepatite C Côte d’Azur Network) remained convinced that this disease, thanks to awareness, screening and therapeutic progress, would be a day eradicated. And this is (almost) the case, since more than 95% of people infected with the hepatitis C virus are today cured thanks to direct-acting antivirals. “Ten years ago, I saw five patients with hepatitis C per day; now, it’s one every two months. The disease is now eradicated in the general population, with only a few outbreaks remaining among drug users”observes the hepatologist.

Silent evolution

This is a new challenge that the RHECCA network intends to take on today: fighting against chronic liver diseases, linked to two major causes: alcohol and MASH (or fatty liver disease). Although these diseases are potentially serious, they struggle to be detected due to a lack of “reporting”. “They are silent in most cases, starting with inflammation which often goes unnoticed”explains Dr. Ouzan. Unnoticed but not painless for the liver. “This chronic inflammation creates fibrosis which gradually worsens and evolves without symptoms, towards cirrhosis and liver cancer, if the cause is not treated.”

Screening test

The only lever: raise awareness among the population, and particularly people who are overweight and/or consume excess alcohol, about these chronic diseases and the importance of screening. And this is what the network is working towards, via its “Protect your liver” communication campaign widely distributed across the country. “We encourage people who have risk factors for chronic liver disease to talk to their doctor. The goal is to be screened using a very simple liver fibrosis screening test called FIB-4 (Fibrosis-4 index). Since October 1, 2020, all city medical analysis laboratories in the Alpes-Maritimes department, and now in almost all of France, calculate this test, as long as the medical prescription includes the measurement of transaminases and blood platelets”indicates the D^r Ouzan.

What’s next? “The attending physician, on the basis of the results of the test, indicating a low, intermediate or high risk, can then provide advice adapted to each situation. This may involve simple nutritional advice to promote weight loss, knowing that it is very effective against MASH or to help limit alcohol consumption (no more than two drinks and not every day). “

A well-oiled protocol supported by health insurance and which aims to prevent potentially serious illnesses. And as the saying goes, prevention is better than cure.

1. Below 1.3 for those under 65 and 2 for those over 65, there is no risk. Between 1.3/2 and 2.67: intermediate risk. Above 2.67, the risk of severe fibrosis is estimated at 80%.