My son, 48, is a recovering alcoholic who hasn’t touched a drink in six months. He was recently diagnosed with fatty liver disease; he has read that this may be the cause cancer and is extremely anxious, even though his GP thought nothing was wrong. My son is otherwise active and now takes care of himself.
Name and address provided.
Dr. Martin Scurr replies: Fatty liver disease is a common condition; As the name suggests, fat builds up in the liver, which affects its functioning and can cause damage over time.
Broadly speaking, there are two types of fatty liver disease: Non-alcoholic fatty liver disease, which is associated with obesity – and is now officially known as metabolic dysfunction-associated steatotic liver disease (MASLD). Many people who have it actually drink little alcohol.
Fatty liver disease is a common condition; As the name suggests, fat builds up in the liver, which affects its functioning and can cause damage over time
Your son has the other type: metabolic disorders and alcohol-associated liver disease (MetALD), which involves not only fat accumulation but also inflammation and damage caused by alcohol consumption.
Both types of fatty liver disease can lead to scarring (cirrhosis), which is a risk factor for cancer, but the risk is greater with MetALD.
Heavy drinking can quickly cause fat to accumulate in the liver within two weeks, research shows.
About a third of patients with alcohol-related fatty liver disease will progress to the inflammatory stage if they continue drinking and 16 percent of them will develop cirrhosis. Ultimately, a small proportion will develop cancer.
Fatty liver disease, whatever the cause, usually only leads to symptoms when the liver is severely damaged – these include general feelings of weakness, swelling (in the ankles and stomach), loss of appetite, vomiting blood, blood in the stool and yellowing of the eyes or the skin.
But this is not inevitable and the damage can be stopped – and even reversed – once the person stops drinking alcohol (or, in the case of MASLD, loses weight).
The liver is the only major organ in the body that can completely regenerate within a few months, and do so quickly.
It sounds like your son has avoided this later stage; his anxiety about his fatty liver disease diagnosis may help him maintain his abstinence. Since he has been abstinent for six months, I imagine his liver function has almost fully recovered.
I am 74 and have recently had frequent bladder infections. I wonder if vaginal prolapse involving a rectocele could be a contributing factor? I have been prescribed a penicillin-based antibiotic for the bladder infection that has caused acute diarrhea. Should I stop this early? I am a retired nurse.
P Wells, Aylesbury, Bucks.
Dr. Martin Scurr replies: As a nurse, you understand the anatomy of your problem, but first let me explain it to other readers.
A rectocele is the term for a prolapse in which weakness in your pelvic floor causes the rectum to sink against the vaginal wall.
However, recurrent cystitis (a urinary tract infection or UTI) is not a recognized consequence of a rectocele; it is something that can occur with bladder prolapse (known as cystocele).
That said, many women your age have recurrent cystitis and this is not necessarily related to organ prolapse, but rather due to changes due to the drop in estrogen levels after menopause.
For recurrent urinary tract infections it is important that the correct antibiotic is prescribed, with a urine sample sent to a laboratory for testing to identify the bacteria causing it (a step that is too often skipped).
Then an option is to give a low dose of antibiotics daily for a few months as a preventive measure. This can be effective, but must be carefully weighed against the potential risk of antibiotic resistance, developing a drug allergy, or disrupting the gut microbiome (the community of microbes that live in your gut and play an important role in maintaining health) .
Some antibiotics often cause diarrhea, for example co-amoxiclav.
Rather than stopping the antibiotic treatment early, I would ask your GP for an alternative option after explaining what has happened.
Another option is a new vaccine, administered as a spray under the tongue, aimed at preventing recurrent urinary tract infections in women.
It contains four types of inactivated bacteria, which are often involved in cystitis, and is taken daily for three months. Studies have shown that this strategy is effective in more than half of women who suffer from chronic bladder infections: it may be worth discussing this with your doctor as well.