This article discusses the challenges in diagnosing chronic liver disease (CLD) due to its early symptoms resembling other conditions and highlights misconceptions about CLD. It also emphasises the significance of new ICD-10 codes for hepatic encephalopathy (HE) in improving patient management.

On the list of the most common causes of death across the globe, cirrhosis clocks in at number 11. Often a result of chronic liver disease (CLD), cirrhosis has been increasingly diagnosed in patients in the US—especially during the COVID-19 pandemic, according to the Journal of Hepatology.[1]  But despite its prevalence, CLD can be difficult to diagnose.

Why CLD gets overlooked by patients

One of the more challenging aspects of CLD is the fact that doctors can sometimes miss it in its early stages of development. According to Abby Philips, BBS, MD, DM, this is because the symptoms of CLD may seem relatively benign at first.

“Many patients only complain of a generalized change in skin colour (hyperpigmentation) or specific skin changes such as acanthosis (black pigmentation over specific regions of the body, especially face, neck, and underarms) that may be seen in diabetes, low functioning thyroid, or obesity, which they already harbour,” Dr Philips said. 

"These symptoms do get overlooked many times because they tend to be nonspecific and can be seen even in various benign conditions."

— Abby Philips, BBS, MD, DM

And, as with any disease, early diagnosis is critical for better prognosis and improved overall health outcomes, according to the first edition of the Liver Health Annual Trends Report issued by Salix Pharmaceuticals.[2]

Dr. Philips believes one way to address the issue of late diagnosis is to identify patient risk factors for cirrhosis.

“Every patient with obesity or metabolic syndrome, or alcohol use or misuse, or healthcare workers (because of their exposure to hepatitis B and C) and patients with a history of liver disease among the immediate family—all of these should ideally be advised for screening for chronic liver disease,” Dr Philips said.

Common misconceptions about CLD

Another obstacle associated with CLD is the array of misconceptions surrounding it. To Dr. Philips, one of the biggest misconceptions is that cirrhosis can’t be reversed.

"Even in stages where cirrhosis has resulted in high liver pressures (portal hypertension), studies have shown that control of the cause of cirrhosis can help reverse cirrhosis and reduce portal hypertension."

— Abby Philips, BBS, MD, DM

Another misconception is that cirrhosis can be healed via restrictive diets. “This is wholly untrue,” says Dr. Philips. 

Similarly, there is a prevailing belief that herbal and dietary supplements are effective and safe to use. Not so, according to Dr. Philips. He cites turmeric and green tea extracts as confirmed liver toxins.

The precise nature of CLD is also subject to misunderstanding. An article published by StatNews.com clarifies that “nonalcoholic fatty liver disease (NAFLD) is the most common form of liver disease in the U.S. with a mortality rate associated with its progression to decompensated cirrhosis or hepatocellular carcinoma.”[3]

Improving treatment of HE with new codes

The StatNews.com authors also discuss an important complication of CLD, which is hepatic encephalopathy (HE).

Up to 80% of patients with cirrhosis develop HE, a disorder that can lead to a wide range of undesirable changes in behaviour and personality. Fortunately, efforts are underway to improve health outcomes for patients with HE.

This code provides certain advantages.

For one, K76.82 is specific to HE, which will allow HCPs to document the diagnosis accurately. In addition, the use of the code will create access to demographic data pertaining to the impact HE has on patients of different genders, races, ages, and geographic locations.

Finally, the new ICD-10-CM code will help to secure appropriate clinical management for patients living with HE, according to StatNews.com.

Dr Philips agrees, stating that the new, more focused ICD-10 code “improves on the understanding that the patient has liver disease and an associated clinical complication for which a specific therapy is required.”

There are still many aspects left to understand regarding CLD, cirrhosis, and HE. However, the specificity of the new ICD-10-CM code, as well as earlier recognition of indicative symptoms, may pave the way to better health outcomes for patients with this disease.

Disclaimer: This story is contributed by Jules Murtha and is a part of our Global Content Initiative, where we feature selected stories from our Global network which we believe would be most useful and informative to our doctor members.