Liver disease in Europe

Abstract

Liver disease refers to a wide spectrum of both acuteconditions caused by various injurious agents, such asviruses, toxins, alcohol and pharmacological agents, aswell as chronic liver diseases, which may over time leadto cirrhosis. Cirrhosis, from whatever cause, predisposesto hepatocellular carcinoma, a primary liver cancer,particularly if the cirrhosis is caused by hepatitis B or Cinfection.Most acute liver diseases can be managed conserva-tively or by withdrawing the hepatotoxic agent respon-sible. Severe acute liver damage may result in liverfailure, or be so overwhelming as to induce irreversibleliver damage (fulminant liver failure), which is associ-ated with significant mortality rates.A proportion of acute infections and diseases maycause ongoing liver injury, resulting in chronic liverdisease and cirrhosis. Like acute liver damage, chronicdisease often goes undiagnosed during the early stagesof the condition. Many cases only present to practi-tioners when substantial permanent damage hasalready occurred, at which time signs of liver failureand or cirrhosis are apparent. A minority of cases aredetected at an earlier stage, either as a result ofscreening of families for inherited liver disease or as aresult of abnormal liver function being found on bloodtests performed during a routine medical examination.The liver is the major organ involved in a numberof key metabolic processes. Damaged or reducedfunctional capacity can result in jaundice, hypogly-caemia, prolonged blood clotting, protein malnutri-tion, increased risk of infection, confusion, impairedlung and kidney function, fluid retention and fatigue.In addition, severe liver disease is often linked tovague symptoms such as malaise and fatigue, all ofwhich results in significant morbidity, greatly impair-ing an individual’s quality of life. Liver failure of anydegree, once present, is associated with a significantlyincreased risk of premature death.The major liver diseases from a public health perspec-tive are hepatitis C and B infection, alcoholic liverdisease, primary liver cancer and haemochromatosis.The substantial public health impact of chronic liverdisease can be gauged from the reported death rate per100 000 population, although the figures may not betruly representative as mortality figures are underesti-mated in some countries. Data are available for thecurrent EU states (Table 1).The differences observed between countries mainlyreflect regional variations in the incidence of hepatitisB and hepatitis C infection (Figure 1, 2). Unfortu-nately, comparative figures for countries on theeastern and southern borders of the European Unionare not available. However, World Health Organiza-tion data on the incidence of viral hepatitis per100 000 population clearly shows the very greatburden of hepatitis, even with the likelihood of under-reporting. The incidence of hepatitis C is reported as:Czechoslovakia 3.11, Estonia 26.65, Latvia 12.52,Russia 22.12, Ukraine 9.46, Croatia 3.38, Macedonia1.28, Albania 4.37; and of hepatitis B: Romania12.01, Russia 44.18, Ukraine 18.85, Belarus 9.34,Georgia 10.22, Moldavia 17.58, Yugoslavia 3.68.These data are relevant as several of these states arejoining the European Union in the near future, and inaddition many economic migrants and asylum seekerswho journey to the European Union originate fromthis part of the world. It would therefore appear thatboth hepatitis B- and C-induced liver damage areconditions that will account for significantly moremorbidity and mortality in the European Union in thefuture.