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ECMC Hepatology Services
Dr. Anthony Martinez discusses the ECMC hepatology services for liver disease, viral hepatitis, alcoholism, fatty liver disease, and hepatitis C virus and HIV co-infection.
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Learn more about Anthony Martinez, MD
Anthony Martinez, MD
As medical director of hepatology at ECMC, Dr. Anthony Martinez cares for outpatients with liver disease, including viral hepatitis, alcoholism, and fatty liver disease. In collaboration with the division of infectious diseases, he also evaluates and treats patients with hepatitis C virus (HCV) and HIV co-infection.Learn more about Anthony Martinez, MD
Transcription:
Bill Klaproth (Host): If you’ve been diagnosed with a liver condition, ECMC’s hepatology services offer specialized treatment and care for you. So here to help us understand liver conditions and the treatment options is Dr. Anthony Martinez, the medical director of hepatology at ECMC. Dr. Martinez, thanks for being here today.
Dr. Anthony Martinez (Guest): Thanks Bill, thank you very much for having me on the show this afternoon. I appreciate it.
Host: First off, your title, Dr. Martinez, what is a hepatologist?
Dr. Martinez: So hepatology is the study of liver disease, just to put it really simply, and there’s a lot of different disease states that fall under that umbrella.
Host: So when it comes to liver disease, who is most at risk?
Dr. Martinez: You know there’s – this can affect a wide range of people. As I said, liver disease has a lot of different etiologies or causes, so one of the biggest problems that we have in the United States today is what we call fatty liver disease. This is an issue that affects 35 million Americans. So this is something that effects a wide ranging group of people, and then we have certain subsets of the population that may be effected by things like viral hepatitis or autoimmune hepatitis. So really who’s at risk? I don’t mean to say anybody and everybody, but it really is specific to disease state – to the exact etiology.
Host: Okay, Dr. Martinez, before we dig into fatty liver disease and viral hepatitis, let me ask you this, are there common symptoms we should be aware of?
Dr. Martinez: Yeah so that’s a great question. A lot of times liver disease, and again this really is specific to the etiology, but viral hepatitis for example often has no symptoms. The same way with fatty liver disease, often times there’s no symptoms. Frequently when we do see symptoms of liver disease, it typically tends to occur late in the disease state. So once the patient’s had untreated liver disease for a long period of time, they develop cirrhosis, and that’s typically when we do see symptoms such as, we call it ascites, so your abdomen fills up with fluid. Your legs may swell. We see a problem called jaundice. So people are pretty familiar with that term, it’s yellowing of the eyes and yellowing of the skin. You may be at risk of increased bleeding, nose bleeds, bleeding from your gums, even internal bleeding. So really if you do have symptoms, we see it, speaking very generally, we tend to see it late in the disease state, but again, certain etiologies may manifest symptoms much earlier.
Host: Okay Dr. Martinez, let’s get into some of these different liver conditions starting with viral hepatitis.
Dr. Martinez: Yeah so the common things that – under that umbrella, there’s viral hepatitis A, B, and C and A is kind of one that is self limiting, meaning you get exposed to it and it just kind of goes away on it’s own after an acute illness, and that’s one that we can immunize you and protect you from so that you don’t actually get sick from it. Then we have hepatitis B. Hepatitis B is transmitted by blood to blood contact, and we see that a lot – in Buffalo we have a big refuge population and it’s endemic to certain areas of the world, so we do have a large population of people that have that. Hep B is one that is not – at this current time is not curable. It’s manageable. There’s medications that we can treat it with, and I think in the next few years you’re going to see developments in the newer medications that come out where we can actually cure hep B. We also have an immunization for that where we can – in the US most children now receive that immunization series when they’re babies, so it’s not as big a problem in the United States for people who are born here. And finally we have hepatitis C, which is another one that’s spread from blood to blood contact, and this is really pretty common in the Baby Boomer population. There’s about 2.5 million people in the US that are still living with hep C, and for a long time it wasn’t curable, and a lot of those medications have changed now, and we have these really simple, short, oral based regimens that are really safe and the cure rate of hep C nowadays is like 98%. So that’s something we see a lot of in the clinic, but that’s kind of the umbrella of viral hepatitis.
Host: Well that’s really good to know. So A, B, and C, A goes away, B is treatable and management, and C for the most part is curable. So you had also mentioned fatty liver disease. What is that?
Dr. Martinez: Yeah so fatty liver – imagine like when you go to the supermarket and you go to buy steak and you know you see that white marbling throughout the steak and it’s basically fat within the tissue and what might give the meat flavor can create harm in humans. So if you carry a lot of weight around your abdomen, essentially what happens is that the fat in your abdomen, it pushes back into the liver tissue, and over time that fat within the liver tissue it creates inflammation, and as time goes by, maybe 20-25 years, that fatty – that inflammation turns into scar, and as more and more scar develops, you become at risk for developing cirrhosis. Now that becomes a problem because when the liver’s completely scarred up like that, it doesn’t function properly. It’s also at risk for developing liver cancer. So this is a problem, as I said that effects about 35 million Americans, and it’s part of this metabolic syndrome that you’ve probably heard about, which is kind of this constellation of diseases, like diabetes, hyperlipidemia, hypertension, these are the patients that are most at risk of developing fatty liver disease. In terms of treatment, to date really the main things are careful control of blood sugar if you’re a diabetic, weight loss, exercise, those are sort of the mainstays of therapy, and we know that when you lose weight and you improve your diet, you can reverse some of that fatty infiltration in the liver and improve the inflammation. There’s a lot of clinical trials that are ongoing right now to develop new medications that impact that inflammatory cascade and prevent the development of scarring, and there’s also medications that are actually even looking at reversal of scarring that may already be there, and this is one of the things at ECMC – we currently offer a number of different clinical trials looking at this exact disease state. So we have some really cutting edge, novel things that are going on here at ECMC, studying some of these newer medications. We also have a new machine. It’s called a Fibroscan and this machine is really high tech and it replaces the need for getting a liver biopsy to determine how much fat is in the liver or how much damage is within the liver. It’s like an ultrasound machine, it’s noninvasive, takes about 10 minutes to do, and it gives us a very accurate assessment of how much scarring and how much inflammation exists inside the liver. So we just started up with the machine. It’s available to everybody right now here at the hospital. Like I said, it’s covered by insurance and it takes about 10 minutes to do.
Host: Dr. Martinez, do most of us have a little bit of this going on or is fatty liver disease more of an extreme thing?
Dr. Martinez: That’s a really good question. If you look at enough scans, I think that, especially if the population ages and people’s weight tends to fall on the heavier side, more often than not I think most people may have some component of fatty liver disease, and keep in mind too that there’s a subset of patients – about 20% of patients will have a very aggressive form of fatty liver disease called NASH, and they may not be obese. These may be very thin people who are actually effected by this.
Host: So let’s turn to HIV coinfection. What is that?
Dr. Martinez: Okay so, I think everybody knows what HIV is, and one issue among HIV patients is about 30% to 40% of them are going to be coinfected with hepatitis C. So a lot of times when you’re exposed to HIV, you get exposed to hep C at the same time and there’s also a group of patients that get sort of this trifecta of hep C, HIV, and hep B. So that kind of – the coinfection just refers to the having been infected by multiple viruses. If you do have HIV and you do happen to have hep C at the same time, the treatment is identical as if you just had hep C alone. It’s just as curable. It’s the same treatment regimens and all of those patients who – if you do have HIV and you happen to have untreated hep C, those are all eligible for treatment with the same cure rate.
Host: Wow, that’s really interesting. Did not know that. Well thanks for sharing that with us Dr. Martinez. Let me ask you this then, when we think of cirrhosis of the liver or somebody with liver problems, we always – I think our perception is, oh was that person a heavy drinker? How does alcoholism play into all of this?
Dr. Martinez: Yeah so alcoholic liver disease in and of itself is it’s own entity, and obviously heavy drinking can create the same type of inflammation and scarring that leads to cirrhosis. How much is too much? You know there’s a lot of factors at play. We have people that consume maybe two glasses of wine a day and they have end stage liver disease. We have people that drink a case a day and their liver has almost no damage. So there’s genetic factors, there’s – we call them host factors, meaning biological differences among people that your alcohol intake may be influenced by, okay? Any of these disease states, if you have underlying liver disease from whatever the cause such as the ones that we’ve just talked about, when you do drink, it’s basically like putting gasoline on a fire. So things that may take 20 or 30 years to create a problem, when you put alcohol on top of that, it really just accelerates the damage. So for example, if you have fatty liver and it takes 20 to 25 years to develop cirrhosis, if you’re drinking heavily on top of that, you have two insults on the liver and you may progress to cirrhosis in say 10 or 15 years. So it’s really like an accelerant, just kind of really pushing that pathway forward at a very high rate. I think that would be the best explanation as to how alcohol plays into things.
Host: Important things to remember. Dr. Martinez, thank you so much for your time today, very interesting. We really appreciate your time. For more information on ECMC, please visit ecmc.edu, that’s ecmc.edu. This is the True Care Healthcast from Erie County Medical Center. I’m Bill Klaproth, thanks for listening.
Bill Klaproth (Host): If you’ve been diagnosed with a liver condition, ECMC’s hepatology services offer specialized treatment and care for you. So here to help us understand liver conditions and the treatment options is Dr. Anthony Martinez, the medical director of hepatology at ECMC. Dr. Martinez, thanks for being here today.
Dr. Anthony Martinez (Guest): Thanks Bill, thank you very much for having me on the show this afternoon. I appreciate it.
Host: First off, your title, Dr. Martinez, what is a hepatologist?
Dr. Martinez: So hepatology is the study of liver disease, just to put it really simply, and there’s a lot of different disease states that fall under that umbrella.
Host: So when it comes to liver disease, who is most at risk?
Dr. Martinez: You know there’s – this can affect a wide range of people. As I said, liver disease has a lot of different etiologies or causes, so one of the biggest problems that we have in the United States today is what we call fatty liver disease. This is an issue that affects 35 million Americans. So this is something that effects a wide ranging group of people, and then we have certain subsets of the population that may be effected by things like viral hepatitis or autoimmune hepatitis. So really who’s at risk? I don’t mean to say anybody and everybody, but it really is specific to disease state – to the exact etiology.
Host: Okay, Dr. Martinez, before we dig into fatty liver disease and viral hepatitis, let me ask you this, are there common symptoms we should be aware of?
Dr. Martinez: Yeah so that’s a great question. A lot of times liver disease, and again this really is specific to the etiology, but viral hepatitis for example often has no symptoms. The same way with fatty liver disease, often times there’s no symptoms. Frequently when we do see symptoms of liver disease, it typically tends to occur late in the disease state. So once the patient’s had untreated liver disease for a long period of time, they develop cirrhosis, and that’s typically when we do see symptoms such as, we call it ascites, so your abdomen fills up with fluid. Your legs may swell. We see a problem called jaundice. So people are pretty familiar with that term, it’s yellowing of the eyes and yellowing of the skin. You may be at risk of increased bleeding, nose bleeds, bleeding from your gums, even internal bleeding. So really if you do have symptoms, we see it, speaking very generally, we tend to see it late in the disease state, but again, certain etiologies may manifest symptoms much earlier.
Host: Okay Dr. Martinez, let’s get into some of these different liver conditions starting with viral hepatitis.
Dr. Martinez: Yeah so the common things that – under that umbrella, there’s viral hepatitis A, B, and C and A is kind of one that is self limiting, meaning you get exposed to it and it just kind of goes away on it’s own after an acute illness, and that’s one that we can immunize you and protect you from so that you don’t actually get sick from it. Then we have hepatitis B. Hepatitis B is transmitted by blood to blood contact, and we see that a lot – in Buffalo we have a big refuge population and it’s endemic to certain areas of the world, so we do have a large population of people that have that. Hep B is one that is not – at this current time is not curable. It’s manageable. There’s medications that we can treat it with, and I think in the next few years you’re going to see developments in the newer medications that come out where we can actually cure hep B. We also have an immunization for that where we can – in the US most children now receive that immunization series when they’re babies, so it’s not as big a problem in the United States for people who are born here. And finally we have hepatitis C, which is another one that’s spread from blood to blood contact, and this is really pretty common in the Baby Boomer population. There’s about 2.5 million people in the US that are still living with hep C, and for a long time it wasn’t curable, and a lot of those medications have changed now, and we have these really simple, short, oral based regimens that are really safe and the cure rate of hep C nowadays is like 98%. So that’s something we see a lot of in the clinic, but that’s kind of the umbrella of viral hepatitis.
Host: Well that’s really good to know. So A, B, and C, A goes away, B is treatable and management, and C for the most part is curable. So you had also mentioned fatty liver disease. What is that?
Dr. Martinez: Yeah so fatty liver – imagine like when you go to the supermarket and you go to buy steak and you know you see that white marbling throughout the steak and it’s basically fat within the tissue and what might give the meat flavor can create harm in humans. So if you carry a lot of weight around your abdomen, essentially what happens is that the fat in your abdomen, it pushes back into the liver tissue, and over time that fat within the liver tissue it creates inflammation, and as time goes by, maybe 20-25 years, that fatty – that inflammation turns into scar, and as more and more scar develops, you become at risk for developing cirrhosis. Now that becomes a problem because when the liver’s completely scarred up like that, it doesn’t function properly. It’s also at risk for developing liver cancer. So this is a problem, as I said that effects about 35 million Americans, and it’s part of this metabolic syndrome that you’ve probably heard about, which is kind of this constellation of diseases, like diabetes, hyperlipidemia, hypertension, these are the patients that are most at risk of developing fatty liver disease. In terms of treatment, to date really the main things are careful control of blood sugar if you’re a diabetic, weight loss, exercise, those are sort of the mainstays of therapy, and we know that when you lose weight and you improve your diet, you can reverse some of that fatty infiltration in the liver and improve the inflammation. There’s a lot of clinical trials that are ongoing right now to develop new medications that impact that inflammatory cascade and prevent the development of scarring, and there’s also medications that are actually even looking at reversal of scarring that may already be there, and this is one of the things at ECMC – we currently offer a number of different clinical trials looking at this exact disease state. So we have some really cutting edge, novel things that are going on here at ECMC, studying some of these newer medications. We also have a new machine. It’s called a Fibroscan and this machine is really high tech and it replaces the need for getting a liver biopsy to determine how much fat is in the liver or how much damage is within the liver. It’s like an ultrasound machine, it’s noninvasive, takes about 10 minutes to do, and it gives us a very accurate assessment of how much scarring and how much inflammation exists inside the liver. So we just started up with the machine. It’s available to everybody right now here at the hospital. Like I said, it’s covered by insurance and it takes about 10 minutes to do.
Host: Dr. Martinez, do most of us have a little bit of this going on or is fatty liver disease more of an extreme thing?
Dr. Martinez: That’s a really good question. If you look at enough scans, I think that, especially if the population ages and people’s weight tends to fall on the heavier side, more often than not I think most people may have some component of fatty liver disease, and keep in mind too that there’s a subset of patients – about 20% of patients will have a very aggressive form of fatty liver disease called NASH, and they may not be obese. These may be very thin people who are actually effected by this.
Host: So let’s turn to HIV coinfection. What is that?
Dr. Martinez: Okay so, I think everybody knows what HIV is, and one issue among HIV patients is about 30% to 40% of them are going to be coinfected with hepatitis C. So a lot of times when you’re exposed to HIV, you get exposed to hep C at the same time and there’s also a group of patients that get sort of this trifecta of hep C, HIV, and hep B. So that kind of – the coinfection just refers to the having been infected by multiple viruses. If you do have HIV and you do happen to have hep C at the same time, the treatment is identical as if you just had hep C alone. It’s just as curable. It’s the same treatment regimens and all of those patients who – if you do have HIV and you happen to have untreated hep C, those are all eligible for treatment with the same cure rate.
Host: Wow, that’s really interesting. Did not know that. Well thanks for sharing that with us Dr. Martinez. Let me ask you this then, when we think of cirrhosis of the liver or somebody with liver problems, we always – I think our perception is, oh was that person a heavy drinker? How does alcoholism play into all of this?
Dr. Martinez: Yeah so alcoholic liver disease in and of itself is it’s own entity, and obviously heavy drinking can create the same type of inflammation and scarring that leads to cirrhosis. How much is too much? You know there’s a lot of factors at play. We have people that consume maybe two glasses of wine a day and they have end stage liver disease. We have people that drink a case a day and their liver has almost no damage. So there’s genetic factors, there’s – we call them host factors, meaning biological differences among people that your alcohol intake may be influenced by, okay? Any of these disease states, if you have underlying liver disease from whatever the cause such as the ones that we’ve just talked about, when you do drink, it’s basically like putting gasoline on a fire. So things that may take 20 or 30 years to create a problem, when you put alcohol on top of that, it really just accelerates the damage. So for example, if you have fatty liver and it takes 20 to 25 years to develop cirrhosis, if you’re drinking heavily on top of that, you have two insults on the liver and you may progress to cirrhosis in say 10 or 15 years. So it’s really like an accelerant, just kind of really pushing that pathway forward at a very high rate. I think that would be the best explanation as to how alcohol plays into things.
Host: Important things to remember. Dr. Martinez, thank you so much for your time today, very interesting. We really appreciate your time. For more information on ECMC, please visit ecmc.edu, that’s ecmc.edu. This is the True Care Healthcast from Erie County Medical Center. I’m Bill Klaproth, thanks for listening.