Professor Mark Thursz on looking after your liver and more
Professor Mark Thursz is a consultant hepatologist, director of research at Imperial College Healthcare NHS Trust and head of the NIHR Imperial Biomedical Research Centre, which in 2022 was awarded a five-year grant from the NIHR to support research activity in collaboration with Imperial College London. He is also head of the department of metabolism, digestion and reproduction at Imperial College London. As a hepatologist, Mark specialises in the treatment of liver disease. To mark Love Your Liver month in January 2023, he explains more about the spectrum of liver disease and his career at the Trust.
Tell us about your work at the Trust.
I started at the Trust in 1990 as a clinical registrar and then I moved into research a year later, before moving onto a senior registrar role and finally, a consultant and senior lecturer role.
In my role as consultant hepatologist, I run an outpatient clinic treating patients with a wide spectrum of liver disease from viral hepatitis, autoimmune liver disease, alcohol related and obesity related liver disease, cirrhosis and liver cancer. Every three months I do a session on the wards typically looking after inpatients with liver failure – the biggest cause of which is alcohol. I also attend multidisciplinary meetings and audit meetings.
In my role as Trust director of research, it is my responsibility to coordinate research delivery staff to make sure that the Joint Research Office is processing applications and implementation of grants and commercial trials efficiently. I am keen to see the number of commercial trials grow because this will generate more income and give patients more access to state-of-the-art medicines.
The Biomedical Research Centre is a five-year grant from NIHR to support research activity in collaboration with ICL. There are fourteen main research themes, and each theme lead must build a strategy to deliver their area of research.
What do you love most about working at the Trust?
I have some great colleagues that I really enjoy working with and I truly admire the quality of care that they deliver. Last year I had the unfortunate experience of needing some healthcare intervention myself and there was no doubt that St Mary’s Hospital was where I wanted to be looked after.
What are the most common conditions that you treat at the liver unit?
The biggest condition in my area of research is alcohol related hepatitis or alcohol associated hepatitis – a condition where people become jaundiced and develop features of liver failure within a few days or weeks of drinking heavily. Other inpatients will present with decompensated cirrhosis, characterised by encephalopathy (brain dysfunction), variceal hemorrhage (catastrophic blood loss), or ascites, which is the accumulation of fluid within the abdomen.
The biggest condition for outpatients is nonalcoholic fatty liver disease which is related to type 2 diabetes, hypertension, and hyperlipidemia. Quite often people don't appreciate that being overweight can cause liver disease, as well as diabetes and other complications.
We also work with our colleagues in oncology on liver cancer because all liver cancer patients have an underlying liver disease, often advanced cirrhosis, so they need looking after by both specialties. Finally, although transplantation is done at The Royal Free, we look after the patients in terms of transplant work up and post-transplant care.
What areas of expertise does the liver unit specialise in at the Trust?
In terms of our research, it is mainly viral hepatitis, alcohol related hepatitis and fatty liver disease. Our unit has specialised in Hepatitis B and C for a long time. About 10 years ago, drugs were developed which ensured that 95 per cent to 98 per cent of patients with hep C would be cured from this condition which would otherwise cause cirrhosis and liver cancer. Whereas we used to have clinics full of patients with hep C, they’ve now virtually all been cured.
With help from NHS England, we have taken a public health approach to hep C and gone into drug and alcohol units and the local prison to screen for the condition. Subsequently, we have almost eliminated hep C from west London which is an extraordinary achievement in such a short period.
We have also done a number of studies looking at hep C screening of patients in antenatal care and A&E units and that work has become routine procedure. All patients are now screened in antenatal care and anyone who is having a blood test in A&E is offered a hepatitis and HIV test.
In my area, there are a number of successful trials in alcohol related hepatitis that have been published. We also have a series of transnational research on biomarkers which inform the diagnosis, prognosis or treatment choices in alcoholic hepatitis.
A substantial amount of professional pride can be gained from such research as it has the potential to impact hundreds or thousands of patients.
What kind of approach is used to treat patients and how might this differ from different trusts?
We're not the only major research-oriented teaching hospital in the country, but there are a limited number of hospitals that operate like ours. Research remains a high priority at our Trust, whereas other trusts do not necessarily see the benefits of research despite a number of publications showing that research active hospitals have better outcomes and better staff recruitment and retention which translates into direct benefit for our patients.
January is Love your Liver awareness month. What can we as individuals do to protect our livers and promote good liver health?
It is vital that we look after our liver. The role of the liver is to detox and there are two main things that frequently happen in January that I wholeheartedly encourage people to follow.
The first is Dry January. It is a good idea to limit your alcohol intake as the number one toxin for the liver is alcohol and the biggest cause of the liver failing to detox properly is alcohol related liver disease. However, this habit needs to continue beyond January. Stick within government recommended guidelines on alcohol consumption – no more than 14 units of alcohol per week – and give the liver two or three days’ complete rest from alcohol.
The second is Veganuary, which encourages people to live a vegan lifestyle (abstaining from any animal related food products). It is proven that a Mediterranean diet, which emphasises fruits, vegetables, legumes, whole grains, and less ultra-processed foods and meat, contains the right number of vitamins, antioxidants, and proteins, so any kind of measured diet, such as a vegan diet, is recommended for good liver health.
Are there any other key messages you’d like to share within the context of this awareness month?
One message I’d like to share this Love Your Liver awareness month is around healthcare screening. Liver disease is almost invariably asymptomatic, so you’re not aware that you're developing the disease until you've got very advanced cirrhosis or liver cancer. Therefore, it is important to detect liver disease early.
In order to get your liver looked at, you need some blood tests and preferably a Fibroscan or some other test for liver fibrosis (scarring). These are widely available in primary care in north west London and other regions. So, get a test if you are concerned about your liver, if you have risk factors like excess alcohol consumption, or just for peace of mind.
Find out more about the work of the NIHR Imperial Biomedical Research Centre.
