Liver disease referrals to an urban, hospital-based hepatology outpatient clinic over the past 25 years.

Micah Grubert Van Iderstine,Eurielle Villarin,Daniel Iluz‐Freundlich,Casandra Dolovich,Gerald Y Minuk

doi:10.1002/jgh3.12286

Abstract

BackgroundAdditional hepatologists are required to manage the rapidly increasing number of patients with liver disease. One disincentive to trainees considering a career in hepatology is the longstanding perception that outpatient hepatology consists largely of managing patients with alcohol‐induced liver disease (ALD).ObjectivesTo document the types of liver diseases and changes in liver disease referrals to an urban outpatient liver disease clinic over the past 25 years.MethodsThe nature of the liver disorder, age, gender, and socioeconomic status of patients referred to an urban, hospital‐based, liver diseases outpatient program were documented from 1992 to 2017. Joinpoint analysis was performed to identify significant trends in referral prevalence rates of various disorders.ResultsIn 1992/1993, hepatitis C virus (HCV), followed by hepatitis B virus (HBV), “other”, non‐alcoholic fatty liver disease (NAFLD), and primary biliary cholangitis (PBC) were the most common underlying liver diseases in referred patients (39, 36, 12, 4.5, and 3.5% respectively), whereas in 2016/2017, NAFLD, HBV, HCV, “other,” and ALD were most common (60, 15, 12, 8.7, and 3.3%, respectively). Aside from NAFLD referrals, which consistently increased over the 25‐year period, the prevalence of all other liver disease referrals fluctuated but generally declined. Recently referred patients were significantly older (38 ± 13 years in 1992/1993 and 49 ± 15 years in 2016/2017, P < 0.0001), while gender and socioeconomic status have not changed.ConclusionsHepatology is a diverse, dynamic subspecialty where ALD continues to constitute less than 5% of all patient referrals.

Highlights

Hepatology is a subspecialty of Internal Medicine that has developed rapidly since the early 1980s when liver transplantation was designated a nonexperimental treatment option for patients with advanced liver disease and more recently, in response to increases in the prevalence of viral hepatitis and non-alcoholic fatty liver disease (NAFLD).[1–4] Accompanying the evolution of hepatology has been the need for additional physicians with expertise in the discipline
One of the challenges in attracting trainees to a career in hepatology has been the misperception that alcohol-induced liver disease (ALD) constitutes the vast majority of liver disease they will encounter in their clinical practice
In addition to NAFLD, significant increases were observed in patients with ALD between 1992/1993 and 2006/2007 (APC 32.9%) and “other” liver diseases between 1992/1993 and 2012/2013 (APC 8.6%)

Summary

Introduction

Hepatology is a subspecialty of Internal Medicine that has developed rapidly since the early 1980s when liver transplantation was designated a nonexperimental treatment option for patients with advanced liver disease and more recently, in response to increases in the prevalence of viral hepatitis and non-alcoholic fatty liver disease (NAFLD).[1–4] Accompanying the evolution of hepatology has been the need for additional physicians with expertise in the discipline. In response to that challenge, in 1996, we described the prevalence of liver diseases seen in 1226 adult patients referred to our urban, hospital-based outpatient liver clinic.[5]. Over the past 25 years, risk factors and treatments for many types of acute and chronic liver disease have changed. These changes are likely to have impacted the profile of liver diseases seen in outpatient clinics. Methods: The nature of the liver disorder, age, gender, and socioeconomic status of patients referred to an urban, hospital-based, liver diseases outpatient program were documented from 1992 to 2017. Conclusions: Hepatology is a diverse, dynamic subspecialty where ALD continues to constitute less than 5% of all patient referrals

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