When Navy submarine veteran Patrick Peck discovered that he was at risk of severe liver damage due to fat around the organ, he was surprised.
“I assumed that cirrhosis of the liver just meant that you were a drunk,” he said.
While many believe heavy alcohol consumption to be the sole cause of cirrhosis of the liver, at least 40 percent of the general population is suffering from what is known medically as non-alcoholic fatty liver disease. Left unchecked, it could progress to things like severe scarring of the liver, which will lead to cirrhosis, liver cancer, liver failure or even death.
The American Liver Foundation estimates that around 100 million people in the U.S. are impacted by the disease. Aging and health issues such as obesity, Type 2 diabetes, high blood pressure and cholesterol are some of the primary risk factors for people getting it.
Outside of these risk factors, patients rarely show symptoms and there is no way to identify the disease in a primary care setting. It requires highly specialized screening to find it.
Since no such treatment exists, there is a worldwide study of a new drug treatment for the disease called elafibranor. The medication will be a pill that treats the disease through improving glucose and fat metabolism in the liver. The hope is that the treatment will halt the progression of the disease and, ideally, reverse any scarring or damage that came as a result of it.
For the past few years, Dr. Wing-Kin Syn and his colleagues in gastroenterology at the Ralph H. Johnson VA Medical Center have been part of that study. Now in phase three of that study, which is right before they apply for Food and Drug Administration approval, they are running a clinical trial to test the overall effectiveness of the drug and any potential side effects that may come from taking it.
Peck is one of the patients involved in the trial.
“I feel blessed that all of the things that fell into place to bring me here all came together,” he said.
Since he didn’t consider himself to be a heavy drinker, Peck didn’t suspect that his liver was the cause of his worrisome blood tests results during an annual physical in 2017, although he knew he had Type 2 diabetes.
He was drinking three to four drinks a month, at most, he said.
His mother, who struggled with alcoholism, died from cirrhosis of the liver, so to him, his lack of an intense drinking habit kept his liver safe. After several tests came back inconclusive as far the cause of his blood test results, his primary care physician, Dr. Robert Glass, eventually recommended that he consult Dr. Syn at the VA.
“He was key to me getting to Dr. Syn,” Peck said.
The importance of this connection is that the VA Medical Center is one of the few locations in South Carolina with highly specialized equipment and experts to screen for and treat this specific type of liver disease. They are also one of less than five medical facilities nationally with a new non-invasive ultrasound-based sonar elastography device that can give a detailed examination of liver stiffness to determine if someone has fatty liver disease and the severity of it.
“It reduces your need for a liver biopsy,” Syn said.
When Peck was screened by Syn in August 2017, his results weren’t good.
“He said you have a lot of liver stiffness,” Peck said.
For Peck, Syn believes it was his Type 2 diabetes that put him at risk. In addition to the misconception about alcoholism, Syn and many specialists consistently highlight that fatty liver disease is a pressing public health matter along with diabetes and obesity.
According to the S.C. Department of Health and Environmental Control, one in eight adults have diabetes. In a 2018 report by the United Health Foundation, it found that in the past six years, obesity in South Carolina increased by 11 percent. With Type 2 diabetes and obesity as key factors in causing fatty liver disease, Syn argues that prevalence of the disease is increasing in tandem with the increased rates of obesity and diabetes.
Since it is also a silent disease, meaning the majority of patients will have no symptoms, Syn estimates that there are potentially way more people living with the silent liver disease. In the past where they have seen patients in their 60s with the disease, he said they now have seen patients with it as young as their late 30s.
“Of the 40 percent prevalence in the country, it’s the tip of the iceberg that’s been diagnosed," he said.
Though it is possible for someone to live with the disease without it progressing to cirrhosis, it's still vital for a person to consult with a specialist to confirm that they are one of those lucky individuals, Syn said. Also, since experts have determined that the liver can regenerate, early detection and less damage can make that regeneration a lot easier.
After Peck got confirmation that he had the disease, he was immediately presented with the option to be a part of the clinical trial with elafibranor. After an intense application process and signing a more than 20-page contract, Peck committed to a six-year trial with the drug.
Today, though his stiffness in his liver has reduced, his results look promising, and his diabetes is looking better, neither Syn nor Peck can be certain that he is even getting the drug. While some trial participants were given the actual medication, some were given a placebo.
But because the results have been noticeable, they are hopeful.
“Everything’s been better since I met Dr. Syn,” Peck said.
Syn is even more hopeful that the treatment will be effective and available to the public in the future.
“The bottom line is that the results are promising," he said.