Fighting Liver Disease with Detection, AI and Novel Therapies

Supersized. That’s the frequency of fatty liver disease, and left unchecked it can progress to cancer or liver failure. Hepatologist Maliha Ahmad, MD, an innovator and leader in preventive care for liver disease, believes that re-thinking diagnostics and interventions could change liver health for millions of people.

More than 100 million adults in the United States have some form of liver disease. The most common type, fatty liver disease, has a global prevalence of about 35 percent, which Ahmad noted, climbs higher – to more than 90 percent – among people with diabetes and obesity. Fatty liver disease gradually worsens over 20 to 30 years, without symptoms. Relatively few people are diagnosed until it has progressed to cancer or liver failure.

For a decade Ahmad cared for extremely sick patients in a liver transplant program as Director of Liver Disease Services at St. Joseph’s Regional Medical Center’s Center for Liver Disease and Cancer Care, in Paterson, NJ. The experience prompted her to re-think priorities and identify challenges. “We need to focus on how to detect disease early and implement changes early,” she says. “But we have to find those patients first.” She offered these signposts for progress:

Screening and education

Basic annual blood tests to screen for liver function are the mainstay of early detection. “Then we need to educate internists. They’re the first to interact with the patient. When they notice that liver function is abnormal, that’s the time to ask what other comorbid conditions does this patient have? If you have abnormal liver function and diabetes, the likelihood is high that you have fatty liver disease, hyperlipidemia, obesity.”

Address healthcare disparities

How do you find and treat people who do not have access to doctors and screening? In one approach, with a federally funded FOCUS grant, Ahmad used AI algorithms to diagnose patients who have hepatitis B and C — viral infections of the liver — across hospital electronic medical records.

“Any patient that walked into the hospital, whether the emergency room or the outpatient setting, if they fell into a certain age group, demographic and place of birth, the EMR would send an auto order to check for hepatitis B and C screening.” The algorithm identified thousands of patients. Then a patient navigator linked them to care, such as primary care or specialist care in gastroenterology, hepatology or infectious disease.

Research new treatment options

GLP-1 medications could play a role in preventing fatty liver. They do not act directly on the liver, but they cause weight loss, which is a main treatment for fatty liver disease. In addition, RNA targeted therapies are being studied for liver regeneration.

“There’s a growing knowledge within hepatology about what fatty liver is,” says Ahmad. “It’s been described since the early ‘80s, but it’s kind of been brushed off. Clinicians are recognizing that this is a real problem and are helping initiate early screening. The advent of AI and having a systematic approach is going to help detect early and prevent early. At the end of the day, comorbid conditions need to be improved. It’s a very multidisciplinary approach.”