Q&A With Dr Kieron Lim

Hello, my name is Kieron Lim. I'm the Senior Consultant in Gastroenterology and Hepatology at Mount Elizabeth Hospital in Singapore. I'm also the Director of the Liver Transplant Service at Mount Elizabeth Hospital.

Vital functions of the liver and lifestyle habits that affect the organ

The liver is a vital organ and it's predominantly involved in three key functions. Firstly, it's involved in synthesis or it makes key proteins. These include albumin bile, which helps us to digest fat that we consume in our diets, as well as clotting factors to maintain health. It is also a storage organ, storing vitamins, minerals, as well as glycogen or fuel that we will need when we exercise and for daily living.

It's also a sieve or a filter, and importantly, it breaks down and metabolizes the food that we eat. The carbohydrates, the proteins, and the fat as well as detoxifies and breaks down chemicals and drugs that somebody may consume.

Firstly, I get lots of questions about diet. A low-fat diet in general is recommended that will prevent or reduce the chance of developing fatty liver as well as keeping your cholesterol and blood pressure normal. Coffee has a beneficial effect and an anti-fibrotic effect on the liver.

Alcohol consumption is another important question that many people are curious about. I would recommend for individuals with no existing or no pre-existing liver disease to exercise moderation in alcohol consumption.

The general and internationally recommended consumption or consumption of alcohol is two standard drinks for men and one standard drink for a female per day. For individuals with liver disease or underlying cirrhosis, it is best to avoid and to abstain totally from alcohol.

The third lifestyle factor would be exercise. This is internationally recommended for each individual to engage in 150 minutes of moderate intensity exercise per week.

Common liver problems today and their contributing factors

The three most common liver problems today are fatty liver disease, hepatitis B, and C. Fatty liver disease affects 20 to 40% of individuals around the world. Hepatitis B affects up to 300 million people around the world, 75% of which are concentrated here in Asia. Hepatitis C, in contrast, affects 50 million people around the world.

Those are general figures on how common these problems are. Fatty liver is associated with metabolic syndrome. For people with diabetes, high cholesterol, overweight, perhaps having a sedentary lifestyle and consuming alcohol, are factors that increase the chance of fatty liver disease.

For patients with hepatitis B, the most common reason for HEPI in this part of the world is vertical transmission from mother to child. Hepatitis C, in contrast, is usually associated with more high-risk behaviours, such as intravenous drug use and transfusion related infections, contaminated needles or blood products.

Recent advancements in diagnosis and treatment of liver diseases

These liver diseases can be identified in two ways. One is through blood tests, for example your annual health screening. It’s also important to go for liver imaging. This can be done using an ultrasound scan. There are many diagnostic and therapeutic advancements in liver disease in the last 20 years.

I'll cite a few important examples. In terms of diagnostic testing, dynamic cross-sectional imaging with CT or MRI scans can help us diagnose hepatocellular carcinoma, or primary liver cancer, without the need for a liver biopsy. Transient elastography or fibro scan of the liver can now reliably and accurately quantify the severity of fat and fibrosis in the liver again in a non-invasive fashion without the need of any needles.

In terms of therapeutic advancements, the key game changer has been the treatment for hepatitis C. Recently, medications taken just for three months can result in a cure rate of up to 95 percent. This is in contrast to older treatments which involve injections for six to 12 months, which only resulted in a cure in 50 percent of patients. It’s a shorter and less painful treatment, with a higher success rate. That’s one of the major game changes in the field of hepatology and liver disease.

Another therapeutic advancement is obviously liver transplantation. Liver transplant has been around for the last 50 years, but in the last decade or so, all the centers around the world are providing a fantastic service to our liver patients, and the statistics are more than one year survival, approaching or greater than 90%. This is the true game changer in the field of liver disease.

I would recommend that they consult with a liver specialist for a detailed medical consultation and evaluation, individuals should also undertake regular health screening with laboratory tests and liver imaging with an ultrasound.

Managing patients with liver complexities at Mount Elizabeth Hospital

Mount Elizabeth Hospital in Singapore has both the specialists as well as the technology to treat patients with complex liver conditions. Gastroenterologist and Hepatologist like myself work alongside liver surgeons, GI oncologists, interventional radiologists and ICU intensive care physicians to provide multidisciplinary care for our liver patients. For example, patients in acute liver failure requiring liver or kidney dialysis can be cared for by these doctors in our ICU.

Patients with complications of end stage liver cirrhosis can undergo endoscopy for acute variceal bleeding. For example, tip shunts for refractory ascites as well as treatment for liver cancer. These may include radiofrequency ablation, chemoembolization, surgical resection, or liver transplantation.

Potential liver transplant candidates will be cared for by a large team of specialists, as well as allied health professionals during their pre and post transplant journey.