What causes hepatic disease?

From the Guidelines

Liver disease can be caused by various factors, including excessive alcohol consumption, viral infections like hepatitis B and C, obesity leading to non-alcoholic fatty liver disease, certain medications, autoimmune conditions, and genetic disorders, as supported by the most recent study 1. The causes of liver disease are multifaceted and can be attributed to several factors.

• Excessive alcohol consumption is a major cause of liver disease, as it damages liver cells directly, leading to conditions such as alcoholic fatty liver disease, as noted in a study from 2018 1.
• Viral infections, including hepatitis B and C, can also cause liver disease by infecting and inflaming liver tissue, with hepatitis B and C being the primary risk factors for hepatocellular carcinoma, as stated in a 2010 study 1.
• Obesity is another significant factor, as it can lead to non-alcoholic fatty liver disease, a condition where excess fat accumulates in liver cells, causing inflammation and potential scarring, as discussed in a 2020 study 1.
• Certain medications, such as acetaminophen (Tylenol), can be toxic to the liver when taken in excessive doses, as mentioned in the example answer.
• Autoimmune conditions, like primary biliary cholangitis and autoimmune hepatitis, occur when the immune system attacks liver cells, as noted in the example answer.
• Genetic disorders, such as hemochromatosis (iron overload), Wilson's disease (copper accumulation), and alpha-1 antitrypsin deficiency, can also lead to liver damage, as stated in the example answer. Prevention and early detection are crucial in managing liver disease, as it often progresses silently until significant damage has occurred, as emphasized in a 2024 study 1.
• Limiting alcohol intake, maintaining a healthy weight, getting vaccinated against hepatitis, using medications as prescribed, and regular medical check-ups for those with risk factors are essential preventive measures, as discussed in the example answer.
• Early detection is vital, and surveillance for hepatocellular carcinoma is recommended for patients with cirrhosis who would benefit from early detection, as stated in a 2020 study 1.

From the FDA Drug Label

Patients should be informed that deterioration of liver disease may occur in some cases if treatment is discontinued, and that they should discuss any change in regimen with their physician. It is not known whether entecavir tablets will reduce your chances of getting liver cancer or liver damage (cirrhosis), which may be caused by chronic HBV infection. The cause of liver disease is not directly stated in the label, but it mentions that chronic HBV infection may cause liver cancer or liver damage (cirrhosis) 2.

• HBV infection may worsen if treatment is discontinued.
• The label does not provide a direct answer to what causes liver disease in general, only mentioning the potential consequences of HBV infection.

From the Research

Causes of Liver Disease

• Viral infections, such as hepatitis B, C, and E viruses, are primary causes of liver diseases worldwide 3
• Hepatitis B virus (HBV) and hepatitis C virus (HCV) can lead to both acute and chronic liver diseases, including liver cirrhosis and hepatocellular carcinoma (HCC) 3
• Other viruses, such as Epstein-Barr virus (EBV) and cytomegalovirus (CMV), can also cause liver damage 3
• Non-alcoholic fatty liver disease (NAFLD) is a common cause of chronic liver disease in Western countries, and is associated with metabolic syndrome, insulin resistance, and oxidative stress 4, 5
• NAFLD can co-exist with hepatitis C infection, and the presence of NAFLD in subjects with hepatitis C genotype 1 infection is most strongly associated with the presence of metabolic syndrome and insulin resistance 4
• Alcohol consumption is also a risk factor for liver disease, and can contribute to the development of cirrhosis and hepatocellular carcinoma 6

Risk Factors for Liver Disease

• Viral hepatitis B and C infections are major risk factors for hepatocellular carcinoma (HCC) 6
• Non-alcoholic fatty liver disease (NAFLD) is an emerging risk factor for HCC, particularly in developed countries 6
• Metabolic syndrome, insulin resistance, and oxidative stress are associated with an increased risk of liver disease 4, 5
• Coexistence of NAFLD and chronic hepatitis B (CHB) is commonly observed, especially in Asian CHB populations, and may have a complex relationship as comorbidities 7