Home » Liver » How stigma can delay liver disease diagnosis

Prof. Maria Buti

Chair of EASL Policy and Public Health Committee, EASL

Prof. Jeffrey Lazarus

Member of EASL Policy and Public Health Committee Member, EASL

Reducing stigma associated with liver disease is crucial in helping tackle the condition, according to leading experts in the field.

Stigma surrounding liver disease is hampering the fight against the condition. Experts in the field are concerned that patients are often hesitant in seeking help because of negative connotations associated with it.

Professor Jeffrey Lazarus explains that this stigma arises out of an association of liver disease with alcohol use or drug abuse, or in the case of NAFLD (non-alcoholic fatty liver disease), with obesity.

The reluctance to seek medical help because of stigma is delaying diagnosis and, in turn, leading to poorer outcomes, he adds.

In addition, hepatitis B in Europe has a higher prevalence among people from sub-Saharan Africa, resulting in stigmatisation of migrant communities.

Advocating early diagnosis

But Professor Lazarus, who is Vice-Chair of the European Association for the Study of Liver’s (EASL) International Liver Foundation, stressed that liver disease affects the wider population and is not limited to specific sections of society.

Another concern is discrimination from healthcare professionals, such as withholding liver disease treatment from those who inject drugs.

The reluctance to seek medical help because of stigma is delaying diagnosis and, in turn, leading to poorer outcomes.

“When that stigmatising or discriminatory behaviour is in a healthcare setting, it is a double whammy,” he says. “People do not come back for appointments, but if we detect liver disease early, we can treat it. But if it is later, it may be too late to deliver effective treatment; it could become cancer, or end-stage liver cirrhosis.”

With most people who have liver disease not showing symptoms, EASL advises those who may be at risk to have liver tests. And here, primary care plays a central role.

Professor Maria Buti, Chair of the EASL Policy and Public Health Committee, says an important step would be increase awareness and improve the diagnosis of liver disease among primary care physicians.

The impact of the pandemic

She also notes that the COVID-19 pandemic has had a major impact on liver disease and particularly on hepatitis elimination plans, with less screening activity, and fewer diagnoses as laboratories focus on coronavirus.

As well as healthcare services being overwhelmed, harm reduction and addiction centres have closed or been working on reduced hours.

With liver disease a major cause of mortality in the working-age population in Europe, her concern is that this perfect storm of events will translate into more cases of liver-related conditions such as viral hepatitis, NAFLD/NASH and alcohol-related liver disease.

EASL believes awareness of liver disease needs to be raised among the public and that healthcare professionals should be more aware of the need for de-stigmatising behaviours.

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