Digestion and fatty liver

What is this page about?

Here you will read about two common digestive problems side by side: reflux and indigestion (heartburn, stomach contents coming back up) and fatty liver. Both are often tied to weight, food, activity and the other risk factors for heart and vessel disease.

Reflux and indigestion

What is reflux?

When the contents of the stomach flow back up into the oesophagus, it is called reflux. Sometimes it has no symptoms, and sometimes it causes heartburn (a burning behind the breastbone). When reflux keeps causing troublesome symptoms or complications, it is called GERD (chronic reflux). Indigestion means discomfort after eating or drinking, such as burning, fullness, bloating, nausea and belching.

Symptoms

• A burning in the middle of the chest, behind the breastbone, which may rise up to the throat
• Sour or bitter food or fluid coming back up into the throat and mouth
• Sometimes nausea, chest pain, trouble or pain when swallowing, a long-lasting cough or a hoarse voice
• Some adults have neither burning nor regurgitation

What makes a difference?

These are the known factors:

• Weight: Excess weight and obesity are risk factors, and the doctor may suggest losing weight to ease the symptoms.
• Smoking: Smoking and breathing smoky air are risk factors.
• Timing of meals: If you have symptoms at night or when lying down, eat 3 to 4 hours before bed.
• Raising the head and shoulders during sleep may help.
• Food triggers: Coffee, tea, soft drinks, fatty and spicy food, chocolate, mint, citrus and tomatoes, and alcohol. This list is not the same for everyone, and it is best to work out with your doctor which ones cause you trouble.
• Medicines: Some medicines (including some painkillers, some sedatives and some heart and blood pressure medicines) cause or worsen reflux. Do not stop your medicine on your own. Tell the doctor what you take, and ask the doctor or pharmacist about painkillers and heartburn medicines.
• Hiatal hernia: Part of the stomach rising into the chest is also a factor.

When is it a warning sign?

Do not always treat heartburn as ordinary. These symptoms are warning signs and a reason to see a doctor: trouble or pain when swallowing, repeated vomiting, unexplained weight loss, loss of appetite, blood in vomit or vomit that looks like coffee grounds, black tarry or bloody stool, anaemia from iron deficiency, a lump in the abdomen, or burning that does not get better with changes in habits. Over the long term, untreated reflux can lead to inflammation and ulcers of the oesophagus, narrowing of the oesophagus, and in a small number of people “Barrett’s oesophagus” (which raises the risk of oesophageal cancer).

Fatty liver

What is fatty liver?

It means extra fat has built up in the liver, without heavy alcohol use being the main cause. It is also called NAFLD or MASLD. It has two forms:

• Simple fat: Fat without significant inflammation or damage. It usually does not cause liver complications, and most cases are of this kind.
• Fat with inflammation and damage (NASH or MASH): It can scar the liver (fibrosis) and lead to cirrhosis and sometimes liver cancer.

Scientists do not know why in some people the fat stays simple and in others it reaches this state.

Symptoms

Usually none. Most people learn of it from a test or ultrasound done for another reason. Some have a lot of tiredness, a feeling of being unwell, or discomfort under the right ribs.

Fatty liver and the rest of the body

Do not see fatty liver as only a liver problem:

• Blood sugar: About a third to two thirds of patients with type 2 diabetes also have fatty liver.
• Weight: Fatty liver is far more common in people with excess weight and obesity. Up to 75 percent of people with excess weight may have it.
• Blood fats and blood pressure: Abnormal blood fats (cholesterol and triglycerides), high blood pressure and diabetes often go together and are part of “metabolic syndrome”.
• Heart: In patients with fatty liver, heart and vessel disease is reported as the most common cause of death. So following blood pressure, blood sugar and blood fats matters in fatty liver, alongside following the liver.

How is it diagnosed?

• History and examination: The doctor asks about weight, waist size, activity and eating habits, and also asks about alcohol use to separate alcoholic from non-alcoholic fatty liver. Other causes of liver disease are also checked.
• Blood tests: The liver enzymes (ALT and AST) may be high. From the results of routine tests, scores such as FIB-4 can be calculated, which help to detect or rule out advanced liver scarring. Depending on the doctor’s opinion, other tests may be needed too.
• Imaging: Ultrasound, CT and MRI show fat in the liver but do not show inflammation or scarring, so on their own they cannot tell simple fat from fat with inflammation.
• Elastography: It measures the stiffness of the liver and may show advanced scarring.
• Liver biopsy: It is the only test that confirms NASH. It is not recommended for everyone and is done only in some situations, at the doctor’s opinion.

Treatment and management

The foundation of management is lifestyle change:

• Losing weight: Losing 3 to 5 percent of body weight can reduce liver fat, and 7 to 10 percent may be needed to reduce inflammation and scarring. Lose weight gradually. Rapid weight loss and malnutrition can make liver disease worse.
• Food: Nutritious food, balanced portion sizes and a healthy weight. Cut down on sugary drinks and high-sugar food.
• Activity: Regular physical activity is helpful even without weight loss. The usual goal is at least 150 minutes a week.
• Tobacco: Stop smoking.
• Medicine and supplements: Sources do not agree: one says no medicine is approved for fatty liver and another says a liver specialist may prescribe medicine if there is liver damage. The decision is up to your doctor. Before taking vitamins, supplements or herbal remedies, talk to the doctor, because some herbal remedies damage the liver.

Follow-up and self-care

• People with fatty liver are usually advised to visit at least once a year and have tests every 2 to 3 years. Your plan will be set by your doctor.
• Follow your blood sugar, blood pressure and blood fats too.

When to get help

Call 115 (Iran’s emergency number) immediately if you have sudden chest pain or pressure that does not go away, even if it feels like burning or indigestion, especially if it spreads to the arm, neck, jaw, abdomen or back, or comes with sweating, nausea, light-headedness or shortness of breath. Do not drive yourself. Fresh blood or a coffee-ground-like material in vomit is a sign of bleeding in the digestive tract: call 115 immediately, even if the vomiting has stopped. Black tarry or bloody stool should also be seen the same day, and if it comes with weakness, dizziness, paleness or feeling very unwell, call 115 immediately.

See a doctor if heartburn and indigestion are frequent, if you have trouble swallowing, repeated vomiting or unexplained weight loss, or if a test or ultrasound has said you have fatty liver or a high liver enzyme.

Every patient’s treatment plan is different. Ask your doctor about your own situation.