Hepatology was for many years practiced primarily in large tertiary care centers. The increase in the number of patients with chronic liver disease (especially nonalcoholic fatty liver disease) has spurred the demand for hepatology services. The advent of easy-to-use, effective treatment regimens for hepatitis C has allowed for effective management of many liver disease patients in the community. Dr. Klaus Gottlieb in Templeton, CA, started first treating patients with Hepatitis C in the late 1990’s when he was an Assistant Professor of Medicine at Indiana University Medical Center. The success rate was then fairly low. Since that time tremendous advances have been made and most patients with Hepatitis C can be cured. While a deep understanding of molecular biology and virology is not necessary to successfully treat patients for Hepatitis C, a grounding in these subject areas, which Dr. Gottlieb acquired at Johns Hopkins University (Master of Science in Biotechnology), helps to select the best treatment for individual patients from the many drugs that are available.

Who is a hepatologist and do I need to see one?

There are only few physicians who are board-certified in transplant hepatology (the study of liver diseases), and most of these work at large liver transplant centers. All of them had to be gastroenterologists first: Transplant hepatology training involves one year of additional clinical training after completion of both a basic residency in internal medicine and fellowship training in gastroenterology. All board-certified gastroenterologists have received basic training in liver disease. Approximately 50 gastroenterologists are trained in transplant hepatology each year but more than 20 million Americans have Non-Alcoholic Fatty Liver Disease (NAFLD), to but give just one example.

This illustrates that community gastroenterologists with an interest in liver disease, like Dr. Klaus Gottlieb, still provide most of the care of patients with liver problems. They often have close relationships with transplant hepatologists at liver transplant medical centers to whom they refer eligible patients for further evaluation. Frequently they co-manage patients together with the transplant center after liver transplantation. They provide emergency care for liver patients when they get acutely ill, for example, by treating acute upper GI tract bleeding from esophageal varices and manage most patients with chronic liver disease.

It takes a long time for end-stage (or obvious) liver disease to develop. In the early stages there may only mild abnormalities of blood tests.

I have slightly abnormal liver tests – should I worry?

Cirrhosis or advanced fibrosis often develops without any signs and symptoms other than minimally elevated transaminases (liver tests). Even ‘slightly’ abnormal liver tests can be serious, for example, when the underlying cause is NASH (non-alcoholic steatohepatitis), a subtype of Non-Alcoholic Fatty Liver Disease (NAFLD). The diagnosis of NASH may require a liver biopsy for diagnosis as there is no simple blood test. If you have abnormal liver tests, such as an increased alkaline phophatase, increased transaminases (ALT and AST), or bilirubin, a consultation with a liver specialist or gastroenterologist with an interest in liver disease may be a good idea.

Further information about liver diseases.