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5 things to know about NASH liver disease

Englewood medical office one of few places to get non-invasive screening


Fatty liver is a condition that’s misunderstood too often, one doctor in Englewood says — and that’s a deadly misunderstanding to make.

Marcelo Kugelmas, a doctor with an office at Englewood’s Swedish Medical Center, helps detect problems before it’s too late. His office, a South Denver Gastroenterology location, is one of the only places where patients can get a fibroscan — a non-invasive procedure that can help detect NASH, a kind of liver disease that’s estimated to affect 3 percent to 5 percent of the United States population.

Here are a few things to know about the disease.

What is the disease?

NASH is a term for non-alcoholic steatohepatitis, a severe form of fatty liver disease, which stems from a buildup of fat in the liver that causes inflammation. (“Steato” means fat, and hepatitis is liver inflammation, Kugelmas said.) It usually doesn’t cause symptoms until a person has experienced advanced liver damage — the disease can progress for years without a person knowing they have it.

Left unchecked, it can lead to liver scarring, liver failure, cancer or death. And a similar condition to NASH is also rampant in the country.

“There’s a condition called non-alcoholic fatty liver disease,” Kugelmas said. “It results from accumulation of fat in the liver in people who don’t drink enough alcohol to cause that problem (just) from the alcohol drinking.”

Known as NAFLD, it’s the more general form of the disease — NASH is its more aggressive form, and about one in four NAFLD sufferers may have it, Kugelmas said.

Is this new?

No, but it has become more common over the years. It wasn’t recognized 50 years ago, Kugelmas said.

“Most people think you only get liver disease from drinking too much or from having (viruses) that cause hepatitis, but there are many other reasons for chronic liver disease,” Kugelmas said. “NAFLD and NASH will become, over the next decade or two, the most common cause for liver disease for liver cirrhosis (or scarring), for liver cancer, for patients undergoing liver transplantation and from people dying from liver disease.”

What are the risk factors?

Major risk factors for NASH are Type 2 diabetes, prediabetes, obesity, high cholesterol and high blood pressure. NASH affects Hispanics and men more than other ethnic and gender groups.

Fatty liver disease and NASH can also affect kids, and people who develop it early are likely to end up with more aggressive diseases at a younger age, Kugelmas said. Treatment plans can include lifestyle modifications or the possibility of participating in clinical trials, which help researchers determine if certain treatments are effective.

“You can cure fatty liver — you can get rid of all fat and inflammation, and the scarring depends on each particular individual,” Kugelmas said. Younger livers respond better than old ones, and there is a “point of no return” beyond which doctors can’t make it better, he added.

To do that, they need to check you out.

How does the machine work?

The imaging test, called a fibroscan, is a painless test that’s done with very little preparation — you just need to show up after fasting for three hours.

“There’s no risk,” Kugelmas said.

It assesses the degree of fatty infiltration in the liver and the degree of scarring a person might have. It’s seen by many as equal to a biopsy, which, on the other hand, is invasive, carries some risk and is much more expensive, Kugelmas said.

The fibroscan machine his office uses regularly is one it’s only had for a few months, Kugelmas said. The machines are usually only found at academic institutions, and very few private practices — and only those in urban areas — offer it, Kugelmas said.

Aside from the VA Eastern Colorado Health Care System in Denver, Kugelmas’ office at 499 E. Hampden Ave. is the only place in the Denver metro area that offers the scan technology, based on website information from Echosens, the company that provides the machines. A location in Colorado Springs is the only other place in Colorado at which to get the scan.

How can I prevent liver disease?

Cut out excess calories and processed carbohydrates, Kugelmas said — extra calories get stored as fat. Exercise is key, too, and one hour per day six days a week is recommended, but it varies person-to-person.

“If today is better than yesterday, and tomorrow is better than today, you’re in the right direction,” Kugelmas said.


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