At the Mayo Clinic in Jacksonville, Florida, the liver transplant group is busy handling an onslaught of patients who have come from all over the country in hopes of a chance at life. For many, a liver transplant is their last hope, after being diagnosed with a deadly disease sweeping the nation at epic proportions. People crowd the unit and undergo scores of testing and evaluation in an effort to get on the hospital's coveted transplant list. It's a program with a 94 percent survival rate after liver transplant, one of the highest in the nation.
For many the culprit is a serious form of fatty liver disease called nonalcoholic steatohepatitis, also known as NASH. An outgrowth of the obesity epidemic in the Western world and around the globe, it causes scarring and inflammation that can lead to liver cirrhosis, cardiac and lung complications, liver cancer and death. Yet few people know about it.
Across the United States, millions of people of all ages suffer from this silent killer that slowly morphs from nonalcoholic fatty liver disease, a condition that now affects 89 million in the U.S., according to the Center for Disease Analysis. The National Institutes of Health estimates as many as 30 million people, or 12 percent of U.S. adults, now have NASH.
The effects of the disease — which include fibrosis, ascites (fluid accumulation in the abdomen), bleeding varices in the esophagus and liver cancer — are devastating. "By 2020 NASH will overtake hepatitis C as the No. 1 cause of liver transplantation in the U.S.," says Dr. Maria Yataco, a gastroenterologist who is conducting research on NASH and liver disease at the Mayo Clinic in Jacksonville.
What is even scarier is the fact that liver specialists are seeing patients that are younger and younger with this disease due the rising obesity rates. "Today we are seeing people in their 20s and 30s with NASH," says Dr. Leona Kim-Schluger, a hepatologist and professor at the Recanati/Miller Transplantation Institute at Mount Sinai Hospital in New York. "There is even NASH in the pediatric population."
"Right now it is estimated the U.S. is spending $5 billion annually in health-care costs related to the disease, which include chemotherapy, transplants, tests and hospitalizations," says health-care economist Home Razavi, managing director of the Center for Disease Analysis, who is working with ministers of health around the world to gather data and help them develop a national health strategy for NASH. "But the costs will rise to $18 billion by 2030 if this disease goes unchecked."
In spite of the large U.S. patient population at risk, the CDC has not addressed the crisis, and there is no FDA-approved treatment available, experts point out.
Even worse, signs of the disease are asymptomatic, so a person often is not diagnosed with NASH until it advances to a late stage, when cirrhosis begins to ravage the body, according to Dr. Laurent Fischer, senior vice president and head of global drug development at Allergan.