A recent pilot study found that early screening for chronic liver disease can lead to earlier diagnosis and treatment. The study was conducted by Brown researchers in collaboration with Clínica Esperanza, a health clinic that provides health care to uninsured Rhode Islanders.
The study screened 14 patients who were unaware of their liver conditions prior to the screenings. Using FirboScan — a non-invasive liver scanning method — researchers identified three with fibrosis, or liver scarring, and eight with steatotic liver disease, or excess fat in the liver.
Around 40% of American adults are at risk for or have been diagnosed with steatotic liver disease, according to Paige McLean Diaz, a transplant hepatologist at Brown University Health, who was not involved with the study.
Risk factors for steatotic liver disease include obesity, type two diabetes and high blood pressure, and the disease can lead to scarring, cancer or liver failure if left untreated.
Liver disease tends to more commonly affect those from lower socioeconomic or Hispanic backgrounds, according to Kittichai Promrat, co-author of the study and gastroenterologist and hepatologist at Brown Health.
Those from marginalized groups tend to seek treatment later when liver disease is further advanced, explained co-author Hayley Treloar Padovano, an associate professor of psychiatry and human behavior and of behavioral and social sciences. Seeking treatment when liver disease is further advanced can lead to liver cancer or needing a liver transplant, she added.
This disparity in affected individuals is why the researchers partnered with Clínica Esperanza, according to Promrat. The clinic serves a low-income population, with 98% of patients being 200% below the federal poverty line, according to Morgan Leonard, the clinic’s executive director. Of patients treated at the clinic, 92% speak Spanish as their primary or only language, she added.
Poverty and a lack of English fluency can pose barriers to participation in research, according to Padovano. She stressed the importance of representative research that targets the most affected populations.
“When there’s research opportunities that come about that benefit our patient population, we’re always happy and willing to partner to bring a service to them to make sure that our patients are represented” in studies, Leonard said.
According to Leonard, while the study was successful, there’s still a long way to go in making liver disease screening and treatment accessible, noting the increase in substance use in recent years.
McLean Diaz believes that events promoting or offering free liver screenings, along with education and community outreach, could go a long way toward improving detection and treatment.
“It’s just easier to blame people for their problems than it is to have the resources and time to help them,” Padavano said. “These problems don’t develop overnight, and if we could get more preventative interventions and outreach to the people that need them … then we could really have a big impact on the downstream chronic health effects.”
Patients in the clinic repeatedly told researchers that “it was just wonderful to have someone care … about their health,” Padavano said. “Just listening to people honestly and being invested in their health can be a huge motivator for change.”
Brown essentially owns the FibroScan, which cannot be left to be used at the clinic, according to co-author Mollie Monnig, an associate professor of behavioral and social sciences. The researchers have requested five more years of funding from the National Institutes of Health to continue and expand the study at Clínica Esperanza, Monning added. Meanwhile, the clinic continues to provide service to its patient population in its other capacities.
“We’re remaining committed to making care accessible … and continuing to be a safe place for patients that otherwise really, truly don’t have anywhere else to go,” Leonard said.
