When something may be wrong with your liver, doctors often will order a biopsy to get to the bottom of the problem.
Up until now, it's a procedure that hurts a lot and can be inaccurate. But a new method is being called a game-changer for patients.
Zachary Ross couldn't ignore some symptoms that were bad and getting worse.
"I was in a lot of pain and uncomfortability in my abdomen," Ross said.
A liver biopsy was needed. But finding one that could deliver an accurate diagnosis wasn't easy.
His first test took a sample from only one liver lobe.
"It's taking a pretty big, long needle, going through the skin and into the liver to get a piece of the tissue," Santa Clara Valley Medical Center gastroenterologist Dr. Ann M. Chen said.
"You can watch it and see it actually going into your abdomen to sit there and remove a chunk for this biopsy," Ross said.
"All that was obtained were fibrin, little pieces of clot," Chen said.
Ross' doctors then tried a new approach called an endoscopic ultrasound liver biopsy.
"We can target a needle biopsy very nicely directly into the liver and thereby minimizing potential risks of perforation or bleeding," Chen said.
Longer tissue samples are taken from both lobes of the liver, increasing the likelihood of an accurate diagnosis to 90%.
"We were able to find a cause for his liver disease and help him avoid toxins that were affecting his liver," Chen said.
"I was real happy that this one actually got results," Ross said.
Just as important, he said he didn't feel a thing.
Santa Clara Valley Medical, where Ross had his procedure, is one 10 ten locations across the country that performs the endoscopic ultrasound liver biopsy. Other locations include Pennsylvania and Chicago.
That number is expected to increase as more doctors learn the technology.
LOOKING INSIDE YOUR LIVER
BACKGROUND: There are approximately two million deaths per year worldwide due to liver disease, one million due to complications of cirrhosis and one million due to viral hepatitis and hepatocellular carcinoma. Cirrhosis is currently the 11th most common cause of death globally and liver cancer is the 16th leading cause of death. About two billion people consume alcohol worldwide and around 75 million are diagnosed with alcohol-use disorders and are at risk of alcohol-associated liver disease. Approximately two billion adults are obese or overweight and over 400 million have diabetes; both of which are risk factors for non-alcoholic fatty liver disease and hepatocellular carcinoma. The global prevalence of viral hepatitis remains high, while druginduced liver injury continues to increase as a major cause of acute hepatitis. Liver transplantation is the second most common solid organ transplantation, yet less than ten percent of global transplantation needs are met at current rates. These numbers highlight an important opportunity to improve public health given that most causes of liver diseases are preventable. (Source: https://www.ncbi.nlm.nih.gov/pubmed/30266282)
CAUSES AND RISK FACTORS: Parasites and viruses can infect the liver, causing inflammation that reduces liver function. The viruses that cause liver damage can be spread through blood or semen, contaminated food or water, or close contact with a person who is infected. The most common types of liver infection are hepatitis viruses, including Hepatitis A, Hepatitis B, and Hepatitis C. Diseases in which your immune system attacks certain parts of your body (autoimmune) can affect your liver. Examples include autoimmune hepatitis, primary biliary cirrhosis, and primary sclerosing cholangitis. An abnormal gene inherited from one or both of your parents can cause various substances to build up in your liver, resulting in liver damage. Risk factors that may increase your chance of liver disease include heavy alcohol use, injecting drugs using shared needles, tattoos or body piercings, blood transfusion before 1992, exposure to other people's blood and body fluids, and unprotected sex. Other risk factors are exposure to certain chemicals or toxins, diabetes, and obesity. (Source: https://www.mayoclinic.org/diseases-conditions/liver-problems/symptoms-causes/syc-20374502)
NEW TREATMENT FOR LIVER DISEASE: Researchers found that small activating RNAs (saRNA) can be used as powerful activators of gene expression to target liver disease. They used saRNA to stimulate an increase of CCAAT/enhancer-binding protein alpha (CEBPA), a key regulatory protein that can activate a series of genes. Those genes then act as tumor suppressors by resetting the natural gene regulatory mechanism of liver cells to reduce fibrosis and reverse liver dysfunction. CEBPA activates immune cell maturation, which in turn leads to an immune invasion of tumor microenvironments and ultimately to the reduction of tumor growth. "We believe that this therapeutic approach can be used to block inflammation and treat a variety of cancers," said John Rossi, Ph.D., the Lidow Family Research Chair at City of Hope. "Liver cancer and fatty liver disease are a major world health problem. Our small RNA drug is inexpensive to manufacture and has been proven to be safe in both animal models and human clinical trials." (Source: https://www.cityofhope.org/breakthroughs/using-nanoparticles-to-test-treatment-for-liver-disease)