Lately, I have been seeing several of my patients develop fatty liver disease or what has been termed non-alcoholic steatohepatitis or NASH. They have been on medications for multiple years due to underlying chronic illnesses. It seems that recently this problem has been recognised in the medical literature and is known as drug induced fatty liver disease or DIFLD.
Liver injury for patients that are chronically on medications occur by blocking mitochondrial function in the liver cells. Contributing factors include fat accumulation along with medication use and preexisting conditions such as obesity, insulin resistance, genetic predisposition and alcohol use.
What is Fibrosure Testing?
Fibrosure testing is a blood test that can accurately test for liver fibrosis due to fatty liver disease. Scoring ranges F0 no fibrosis to F4 cirrhosis or scar tissue of the liver. Once cirrhosis is seen, liver failure follows. Initially the body can compensate but as cirrhosis progresses there is no longer compensation and the only resolution for the patient is a liver transplant. With the introduction of treatment for chronic viral hepatitis associated with both Hepatitis B and C with antiviral therapies, fatty liver disease is being looked at as the next major cause of liver failure here in the United States.
Of course, the first line of treatment for DIFLD is to eliminate the drugs that the patient is taking chronically. This may be easier said than done. In one of the cases that my practice is dealing with, the patient had a Fibrosure Score of F3 or severe fibrosis. This patient was started on tirzepatide and now her score is down to F0. I have several other patients that I may be trying this on in the near future, Hopefully there will be happy resolutions with these other patients.
