Doctors are seeing more women and patients under 40 with liver disease | Local News
When Dr. Rita German sees a patient walk through the doors of her multidisciplinary alcoholic liver disease clinic at UW-Madison, she has two thoughts.
First, she hopes the patient won’t need a liver transplant. Then she wonders what could have happened differently. What could have prevented the patient from coming to see her in the first place?
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“We are really good at treating liver disease. We’re not good at getting patients treated for their alcohol disorder,” she said. “There are all these points where we could have intervened before they came to see me. We did them a disservice.”
And those windows to intervene are getting smaller. Increasingly, German said, the patients she sees are in their 20s, 30s and 40s.
“It used to be a disease of the 50s or 60s,” said Dr. Eric Siegal, who directs the intensive care unit at Aurora St. Luke’s Hospital in Milwaukee.
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More women are being diagnosed with the disease, German said.
In south-central Wisconsin – Dane and its surrounding counties – 55 people died of liver disease in 2009, 35 of them from alcoholic liver disease. This made it the 14th leading cause of death in the region. Sixteen, or 30%, were women.
In 2020, 132 people died from liver disease, including 87 from alcoholic liver disease. Fifty-six, or 42%, were women. It now ranks as the eighth leading cause of death in the state.
During the same period, deaths from other chronic liver diseases, such as nonalcoholic chronic liver disease, also increased, said Dr. Veronica Loy, medical director of the liver transplant program at the Medical College of Wisconsin. . In 2009, 20 people died from the disease, which is often associated with high cholesterol, diabetes and obesity, according to Loy. In 2020, 45 died.
By nearly every available measure, deaths from liver disease — a catch-all term for any condition that damages the liver — are on the rise in south-central Wisconsin. Deaths from alcoholic liver disease, the buildup of fat in the liver that progresses to permanent damage with excessive alcohol consumption, have particularly increased.
In the early stages, mild liver disease is “very reversible,” Loy said.
But it can progress to cirrhosis, the replacement of regular healthy liver tissue with scar tissue, leading to jaundice, fluid buildup in the legs and abdomen, bruising, and liver cancer. In the most serious cases, liver failure will lead to death without a transplant.
In other cases, alcoholic hepatitis — liver damage from excessive alcohol consumption over a short period of time — can cause the same results, Loy said. Without a transplant, alcoholic hepatitis can prove fatal within six months, she said.
From 2007 to 2021, Dane County grew from 613 emergency room visits for chronic alcohol at 3,134 per year, not including hospitalizations for alcohol poisoning.
In 2021, UW Health reported seeing liver disease rates “skyrocket among men and women ages 25 to 34… especially young women.
But 2021 was the “tip of the iceberg” for the impacts of COVID-19 on alcohol consumption, German said. Mortality rates have also increased in younger patients, she said.
“When you see people who have their whole lives ahead of them and who see a liver transplant as the only thing left to save their life, it’s quite shocking,” Siegal said.
Siegal said he now sees young people in need of transplants at least every month. He spoke to parents his own age – Siegal is 55 – watching their own children die of liver disease.
Patients, especially young people, are often shocked when they hear they need a liver transplant, German said. But the 30s and 40s no longer surprise her, they come so often.
Liver transplants go to patients most in need first in south-central and southeastern Wisconsin, based on their Model Score for End-Stage Liver Disease, which determines how well a patient has need a transplant. In 2020, Wisconsin patients underwent 188 liver transplants, the most recorded in state history, according to the federal Department of Health and Human Services. Last year, 150 transplants took place. So far this year, there have been 81.
The rising rate of disease further stretches the medical system and means there aren’t enough livers donated for patients, Loy and Siegal said.
“These incremental increases in the number of sick people are starting to bring us closer and closer to a breaking point,” Siegal said. “We are not there yet. But we are certainly stressed.
Wisconsin had problems with binge drinking long before the pandemic, said Maureen Busalacchi, director of the Wisconsin Alcohol Policy Project at the Medical College of Wisconsin.
“We are not close to the rest of the nation,” Busalacchi said. “We are really out of step”
German tells some patients that they can no longer drink without risking death. They sometimes grow back, she says.
“They’re like, ‘Well, what about football Sundays?'”
In 2018, Wisconsin reported a 25.8% prevalence of heavy drinking among adults, according to CDC data — the highest rate in the nation. And Wisconsin residents can buy liquor as early as 6 a.m., due to 2011 legislation.
And doctors have made another point: Women don’t metabolize alcohol at the same rate as men.
“A lot of women are drinking in ways that used to be considered a masculine way of drinking,” Loy said.
Women receive significantly less screening than men for alcohol use disorders, Loy said. When a doctor identifies the disorder, they are less likely to refer it for psychological help or alcohol management. And those who are referred go there less often due to responsibilities such as child care and a perceived stigma, Loy said.
“’Anecdotally, I can see that women are more bothered by this,’ German said.
Wisconsin’s drinking culture has only gotten worse during the pandemic, Loy said.
“The consequences of social isolation, working from home and social pressures have really caused people tremendous stress,” she said. A study she co-authored at the start of the pandemic reported that women with children unable to attend school or daycare, or those with a family history of heavy drinking, had the highest risk of drinking more.
“We’ve definitely seen mothers who have had to deal with the brunt of child care… juggling jobs, staying home more,” German said. “This stress increased their alcohol consumption.”
What to change
To curb excessive alcohol consumption, Busalacchi highlighted a number of interventions detailed in the Wisconsin Alcohol Policy Project document. report on reducing binge drinking in Wisconsin: More liquor age compliance checks at retailers, training volunteers not to overserve customers at festivals, and “putting some checks in place” on who gets a liquor license.
The addition of a statewide “nightcap location” data collection program, which would identify bars and restaurants where those arrested for OWI and assault were served for the last time would reveal which establishments regularly overserve, she said.
“The vast majority of owners are doing a good job,” Busalacchi said. “And then there are a few that are way out there.”
Reforming Wisconsin’s beverage culture presents a challenge, Busalacchi said. But most people don’t want to worry about drunk attendees at events – and she’s also met law enforcement officials who believe that less alcohol consumption will lead to less crime, he said. she declared.
Critically, the public needs better alcohol education. German said: Some patients do not consider drinking beer and wine to be alcohol consumption.
“Patients underreport their alcohol use to physicians,” Shah said. “Whatever they say, we can multiply by 1.5 or 2.”
Early referral or diagnosis can be critical, Shah said. It emphasizes the importance of quitting smoking for the patient. And in the early stages of liver disease, abstaining from drinking can allow the liver to “regenerate completely and recover in 30 to 60 days,” Loy said.
At German’s new clinic, which has seen 50 patients from across the region since it opened last fall with an average age of 48, she refers patients to counseling, Alcoholics Anonymous, social workers and rehabilitation, among other tools – aimed at providing multidisciplinary treatment.
The healthcare system must intervene before patients begin self-medication for mental health issues, Siegal said.
“It’s going to take a huge campaign to get people to understand that responsible and appropriate drinking can be part of normal life,” Siegal said. “But we’ve gone too far for far too many people.”
“It was a disease of the 50s, 60s.”
Dr. Eric SiegalAurora St. Luke’s Hospital
“We are not close to the rest of the nation. We are really out of step. »
Maureen BusalacchiDraft Wisconsin Alcohol Policy