Relying on one of the largest collections of liver tissue samples ever acquired by a single organization, Geisinger Health System researchers have embarked on a massive study of one of the fastest growing liver problems.
Nonalcoholic fatty liver disease starts with the accumulation of fat on the liver, which leads to inflammation and scarring. It can progress to the point of permanent liver damage and lead to the potentially fatal cirrhosis. If the damage becomes too great, a liver transplant may be needed. Linked to America's increasing obesity problem, doctors have predicted a steep increase in the coming years.
The disease is asymptomatic in its early stages and many people don't know they have it initially. Geisinger Health System is leveraging several key system resources in an effort to develop a simple blood test to diagnose the disease. Early detection would likely help patients better manage the disease and could even save lives. Yet a major obstacle needs to be cleared first.
Right now, the only way to definitely diagnose the disease is through a liver biopsy, where a needle is inserted into the skin and liver tissue is collected. However, biopsies can pose health risks because of the potential for bleeding from the liver or for infection.
The goal is to develop a noninvasive blood test for the disease and then bring it to market so other physicians can use it, said Geisinger staff scientist Glenn S. Gerhard, MD.
To that end, Geisinger is uniquely positioned to develop such a test because of the array of resources the system has at its disposal.
Geisinger has collected more than 600 liver tissue and blood samples donated from patients who have undergone bariatric weight loss surgery. That work has been made possible through collaboration among Geisinger researchers, clinicians and surgeons.
Thanks to the very high participation rate of patients, the size of Geisinger's liver tissue and blood sample collection is among the largest of its kind in a research setting, Geisinger officials said.
"Nonalcoholic fatty liver disease hasn't really been studied, in part, because investigators can't get access to samples," Gerhard said. "Most people don't realize they have this disease—they're walking time bombs."
The federal government estimates that the disease affects 2 to 5 percent of Americans, while another 10 to 20 percent of the population has fat in their liver, but no inflammation or liver damage.
As part of the project, investigators from the Weis Center for Research, the Center for Health Research, the Center for Nutrition and Weight Management, and the Department of Surgery are combing through Geisinger's $80 million Electronic Health Record to learn why some obese and overweight people develop nonalcoholic fatty liver disease and similar problems.
"We need to look at what causes this disease and how we can treat it," Gerhard said. "Our patients are graciously giving us the means to answer those questions."
Aside from the personal health toll, there's also a financial cost. For instance, a liver transplant costs about $370,000 on average, while bariatric surgery costs $40,000 in Pennsylvania, depending on the negotiated rate with the person's health plan. (These costs are not what the patient pays, but the average costs for the provider.)