Symptoms

Steve, London, UK:
At what age is liver cirrhosis among the young most prevalent? Also what are the symptoms?

Fergus Walsh:
The problem with cirrhosis of the liver is that it's a cumulative disease and the older you are,the longer you've been drinking, the more likely you are to succumb to it. But it has seen enormous increases.

I have got the Health 2001 annual report in front of me from Professor Liam Donaldson, who is the chief medical officer for England. He says that large rises in death rates from chronic liver disease and cirrhosis have occurred in most age groups. In the 45 to 54 year-olds there's been a four-fold increase since the early 1970s - that's among men and a three-fold increase in women. Of the 35 to 44 year-olds, the rise has been even larger - an eight-fold increase in men and approaching a seven-fold increase in women. In the case of women, for example, cirrhosis of the liver now kills 1600 women every year - that's more than die from cervical cancer.

When it comes to symptoms - this is one of the big problems because cirrhosis of the liver and the damage that's being done, is largely hidden and can be hidden for years and years. It is often when you go along to the doctor with another problem that they pick up cirrhosis of the liver. The doctor can actually feel your liver. The liver is the largest organ in the body - it weighs about 3 pounds and is nearly the size of a football and it basically swells up with fatty tissue, when it gets damaged, and GPs can feel that. When the disease gets further on and there is further damage, it can be tenderness there, swelling and, in the extreme stage, the skin can go yellow, nausea and there are quite a few other symptoms but it is quite late on then.

Newshost:
Steve goes on to ask us exactly what percentage of cirrhosis cases prove to be fatal?

Fergus Walsh:
It depends in what country you are and what sort of healthcare you have near you. But the best figures I have been able to find on this area is that with alcoholics who abstain after their diagnosis, the survival rate after five years, can be as high as 85%. For those who continue drinking, the chances of living beyond five years is no higher than 60%. So it depends how you categorise it and there are lots of other liver complications that can arise from this as well.

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Samuel, UK:
How much is too much and how can one know that one's alcohol consumption is too high? Is it based on age or figures on daily consumption?

Fergus Walsh:
We're dealing with adults here. When the UK Government gives out its healthy drinking message - its been accused in the past of these very "nannying" figures. The general weekly maximum recommended amount for men is 21 units of alcohol and for women it's 14 units.

Let me tell you what a unit of alcohol is - it is roughly a half-a-pint of beer and a glass of wine. Now that's not a very strong glass of wine and not fortified wine and it's not a very strong half-pint of beer. So it's an average glass of wine - 125 millilitres - a serving that you get in the pub and not the ones you would have at home. Transforming that into daily allowances - for a man, you can safely, as an adult, drink up to 2 pints of beer a day. But not every day of the week - say four or five times a week, or up to four small glasses. For women, assuming there are no other health problems, you could safely drink two or three small glasses of wine a day but not every day. It also partly depends if you're a huge great big man then you might be able to take a little bit more alcohol than if you are a very small woman.

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Jamie, UK:
If one stops drinking before the onset of illness, is the unseen damage actually reversible? At what stage with alcohol is the damage actually permanent?

Fergus Walsh:
It's a little bit like with smoking, the sooner you give up the better. Of course smoking and alcohol and quite different. In moderation alcohol is good for you whereas smoking is bad for you full-stop. But with alcohol once you've damaged and scarred the tissue - because that's what cirrhosis of the liver is - it's scarring of the tissue and gradual damage - you can't reverse that. The liver, to a certain extent, will renew itself but you can't reverse it completely. But once you have stopped drinking, you can arrest the damage. The question of how far is too far - if you get to the stage when you have got a diagnosis of cirrhosis of the liver, you really have to give up drinking altogether.

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Alex B, UK:
I have been living in London for six months and I was quite surprised at the advertising billboards, which are everywhere, promoting Alco-Pops to young women in particular. How can we impose restrictions on this kind of advertising?

Fergus Walsh:
This is a question that one would have to aim at Ministers who take the lead on this kind of thing. There is a lot of concern among Ministers about these drinks - Alco-Pops - that young people especially seem to be attracted to. But there has been a shift in the way advertising has been allowed for alcohol. It was only a few years ago that adverts for spirits were banned on the television - they are now allowed - so there has been a change here.

If you go to other European countries - if you go to France or you go to Italy or Germany, generally speaking it's not socially acceptable to turn round and say - we're going to go out and get hammered tonight, or we got hammered last night, I've got a terrible hangover. It's really not seen as anything smart or clever whereas you hear that comment here very often that people have gone out and drunk too much and then they brag about it the next day. There is something that needs to happen if we're going to change that. It needs to become not socially acceptable to go out and get so drunk that you lose either all control or you do permanent damage to your liver. That's the problem, it's this binge drinking, rather than small amounts every day that's really the problem.

These units I mentioned - the 21 units maximum a week for men and the 14 units maximum a week for women - the worse thing you can do is have them all in one go.

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Lisa Courtney, UK:
The news is giving the impression that all cirrhosis of the liver is caused by alcohol abuse and this is not the case. I am 39 years old and in 1995 I was diagnosed as having primary biliary cirrhosis, which is an autoimmune liver disease and this is not in any way connected with alcohol or drugs.

Fergus Walsh:
Lisa, I am very sorry to hear about that. The trouble is when we're doing these news reports we tend to use this sort of shorthand. You're absolutely right, there are lots and lots of other reasons why people get cirrhosis of the liver apart from alcohol. It is the one that most people know about but there a lot of other causes as well.

I have a whole list of things here - the top of the list of course is extensive intake of alcohol. But viral hepatitis, inherited and congenital diseases, problems with the bile duct, some forms of heart disease, severe reactions to drugs and a parasitic infection even. So your quite right Lisa, apologies for that. The problem we have is that when we're dealing with a news story, we tend to use this shorthand and if I had longer, as I do now, I could point out that there are many causes of this problem.

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Genevieve, Wolverhampton, UK:
I am 25 years old and slightly overweight. I do drink quite often and I am quite worried about my liver. Should I see a doctor for a test to see how my liver is? Can this be done?

Fergus Walsh:
Yes it can. If you are worried Genevieve you should go and make an appointment with your GP in the first instance. Then if your GP concerned he or she can refer you on.

As I mentioned earlier, the doctor can actually sometimes feel whether the liver is enlarged. If the doctor wants to take it further, a doctor can refer you along to a hospital where they can take a biopsy. That's putting a very, very fine needle into the liver and they can take a sample of cells and see what's happening there. They can also check things with blood tests as well.

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Kerry Andrews, UK:
Why do you think the number of women drinkers are seen as more important than the number of men who drink? Surely there is still many times more men who drink.

Fergus Walsh:
It's a fair point. I think the reason why most of the media have focused on - and the Government to a certain extent have focused on - women is because that's where the biggest increases have been happening and so is something new. Yet you're quite right, men drink more to excess than women do and there are more men with cirrhosis of the liver than women. It's because the news element here was that young people and women especially have seen this big increase in cirrhosis of the liver so that's why we focused on it. But you're quite right Kerry, the problem is one that men have to deal with as well.

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K Kerrigan, Ireland:
More has to be done to educate young people about the damage alcohol is doing to their bodies. The problem is that people's social life is centred around going to the pub and this has to change.

Rob Davis, UK:
There is continual emphasis placed by certain sections of the media for it to be fashionable for young people to drink themselves into oblivion. Is it not up to the Department of Health to impose stricter guidelines to combat this?

Fergus Walsh:
They are both very fair points. It is obviously not just something for Government, it's something for society as well.

I take an interesting parallel here with the subject of drinking and drinking and driving. Now drinking and driving obviously affects not only your own health but can lead, as we all know, to tragedies. So the amount of drinking and driving and the amount of deaths relating to drinking and driving has gone down enormously. It used to be pretty much socially acceptable, 30 or 40 years ago, to drink and drive and in some countries it still is. But in the UK it is not. This was partly to do with the Government's legislation and police getting tough on drinking and driving. It was also partly to do with society - people saying, if your driving I am not going to serve you another glass of wine. Or if you're going down the pub, nominating somebody to have soft drinks so that everybody else can drink.

So maybe we have to do something there. But it can't just be government, it has to be something to do with society - it has to be to do with young people. Professor Liam Donaldson was saying to us today that it has got to start in the schools with better education but it's also got to be in the home as well with parents setting an example. So it's something for Government but also something for society as well.

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Clark Campbell, Belgium:
There is still a lot of confusion about what exactly a unit of alcohol is. The drink industry should be forced to label all drinks and pubs should do the same. Wouldn't this give the consumers the information we need?

Fergus Walsh:
It is a very interesting suggestion. It has been suggested to the drinks industry from some of the alcohol charities. It wasn't that long ago that bottles of wine didn't used to have the percentages of alcohol on them so you didn't know what you were drinking. In pubs of course the beers do have percentage strength in them. But yes, it would be interesting to know just exactly how many units a pint had. It's something for the drinks industry, it's something for publicans and it's also ultimately something for Government.

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