How COVID-19 Can Affect The Liver

The question always arises regarding COVID and the liver. While COVID causes abnormal liver tests in more than half of infected patients, the vast majority have no long-term liver sequalae. What has affected the liver more is the modified behavior associated with the pandemic. Because of the pandemic, people are more isolated, exercising less and are spending more time at home. As people are not able to attend sporting events or concerts, are working from home or not working at all, and in general are stuck at home, there is little else to do, but eat and drink. The excess eating has led to weight gain in many people, the so-called COVID-19 pounds. In addition, alcohol consumption is up significantly across our communities.

The weight gain and increased alcohol intake has directly led to an increase in the diagnosis two common liver diseases, non-alcoholic liver disease and alcoholic liver disease. The number of hospital admissions for alcohol-related complications has skyrocketed during the period of COVID, specifically from March to the present. This is truly concerning as the incidence of liver disease during the pandemic has reached epidemic proportions and it is not related to the COVID virus itself.

Fatty liver is exactly as it sounds. When people gain weight, fat gets deposited into the liver. Over time, inflammation can occur and the fatty liver can progress to inflammation, fibrosis and eventually cirrhosis, with a very high risk of liver cancer. The treatment of fatty liver is diet and exercise with weight loss, but it takes much longer to get rid of a fatty liver than it does to develop one. With the inactivity and weight gain associated with the current pandemic, fatty liver in our area is on the rise. Hopefully, people will recognize this risk and start a program of exercise and weight loss.

The increased alcohol intake seen during the pandemic is perhaps more concerning than overall weight gain. Ingestion of alcohol may lead to serious condition called alcoholic hepatitis. Alcoholic hepatitis usually occurs after an episode of increased drinking in someone with a history of chronic alcohol use. It is characterized by fever, nausea, pain in the right upper portion of the abdomen and jaundice. Alcoholic hepatitis is frequently confused with an acute gallbladder attack. Most of the time, people with alcoholic hepatitis recover at home and do not seek a doctor’s care. Other times, however, people come to the hospital for care and rarely, this condition can be fatal. Alcoholic hepatitis usually occurs in people with some degree of underlying liver disease. The treatment of alcoholic hepatitis involves the cessation of alcohol and encouraging a good and nutritious diet. Rarely, a short course of corticosteroids is used to treat this condition. In our area, we are seeing a significant rise in the number of serious cases of alcoholic hepatitis being admitted to our hospitals.

Perhaps the most worrisome patients are those that gain weight and increase their alcohol intake. These people develop alcoholic and non-alcoholic fatty liver, and are at a very high risk of developing cirrhosis and its complications. This double whammy has also become quite common since the pandemic began and these patients need to immediately start a diet and exercise program and stop alcohol intake.

So, what have we learned regarding COVID and the liver? We now know that the effects of the modified behaviors in response to COVID are more worrisome than the direct effects of the COVID virus itself on the liver. With the cold weather upon us, it will become more difficult to exercise and with daylight savings time, a seasonal increase in depression will occur. This will likely lead to more people gaining weight and/or increasing their alcohol intake leading to even more cases of acute and chronic liver disease in our area. While we can prevent the COVID virus with social distancing, mask wearing and hand washing, we can also prevent the onset or worsening of liver disease by watching what we eat and drink. Even in a pandemic, a good diet and sensible drinking are important to maintain liver health.

David Bernstein
David Bernstein, MD, is a columnist for Long Island Weekly and chief of gastroenterology, hepatology and nutrition at North Shore University Hospital and Long Island Jewish Medical Center.

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