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Primary care for your liver

Raza Malik, MDMuch like an annual primary care visit or skin check at the dermatologist, Raza Malik, MD, PhD Director of the Liver Center and Associate Chief of Gastroenterology at Tufts Medical Center, says a growing number of Americans would benefit greatly from routine participation in a liver health program.

“I’ve seen first hand the impact alcoholism and obesity has on an individual's health and also from a community and public health standpoint,” he says. “That's what inspires me to create new systems, to create better models of clinical care so that as physicians, we’re tailoring our care towards the patient.”

According to the Centers for Disease Control, nearly two thirds of U.S. adults are overweight or obese. Among the many health risks associated with obesity is the increased incidence of nonalcoholic fatty liver disease, with a buildup of excess fat in the liver that can cause inflammation, cell damage and fibrosis or scarring. Left untreated, nonalcoholic fatty liver disease can lead to cirrhosis, liver failure, liver cancer, heart attack and kidney disease – complications that are expensive to treat and reduce life expectancy. Fatty liver is also a concern among heavy drinkers. It’s the earliest stage of alcohol related liver disease, which can progress to alcoholic hepatitis and cirrhosis.

“It’s estimated that about 90 million Americans have fatty liver disease associated with obesity or alcohol consumption, and as many as three quarters of those people are undiagnosed. So there's a large unmet need there in terms of asymptomatic individuals with liver disease,” says Dr. Malik.

Dr. Malik recommends that patients with type 2 diabetes, a BMI of over 30 or excess alcohol intake (15 standard drinks per week in men and 8 standard drinks per week in women) receive a liver function test and an ultrasound scan of the liver to check for fat. If the tests show any fat on the liver or inflammation related to liver function tests, that’s when the individual should be seen at Tufts Liver Center for a clinical evaluation by a liver specialist and examination of the liver using the FibroScan® advanced ultrasound procedure.
 
“The FibroScan® helps us quantify exactly how much fat and scarring is in the liver so we can determine the exact intervention needed to correct the liver disease and monitor patients over time,” says Dr. Malik. “If these individuals are intervened on earlier with a liver wellness program, we can reduce and often reverse the development of the liver disease, even if there’s already fat, inflammation or early scarring.”

For patients with advanced liver disease, Dr. Malik and the Liver Center team have created a point of care multidisciplinary liver clinic, where patients may see a number of clinicians, including liver specialists, addiction experts, infectious diseases clinicians, liver surgeons, interventional radiologists–all in a single visit.  

“We then conference as a team and develop an integrated, cohesive diagnostic and treatment plan for each individual patient. And because everyone's meeting in the same clinic, it happens sooner than patients going for consults over a period of weeks to months,” says Dr. Malik. “We want to make sure that every service we offer is putting the patient at the center of the equation and providing the best possible care for that patient as if they were a member of our own family.”

To refer a patient or to request an appointment, call 617-636-5883