Managing Fatty Liver and Gastrointestinal Issues: Your Questions Answered

Inquiry and consultation?

Hello Doctor: I had a liver ultrasound today.
I have been associated with the hepatobiliary and gastroenterology department since many years ago due to elevated liver enzymes.
In my younger days, I often stayed up late and had a penchant for sweet foods and drinks.
Later, I developed a mental illness and became associated with the psychiatry department! Currently, I have moderate fatty liver and occasionally experience irritable bowel syndrome (IBS).
I have improved my daily routine, but I still cannot resolve the fatty liver and IBS.
My BMI is overweight, I enjoy sugary drinks and sweet foods, dislike exercise, and love fried foods! I once consumed tea and carbonated drinks to the point of experiencing gastroesophageal reflux, leading to nausea and vomiting watery substances resembling gastric fluid.
I do not want to undergo an endoscopy; I only ask the gastroenterologist to prescribe medication for me.
Additionally, I work in cleaning and have to clean toilets daily, which may expose me to Helicobacter pylori! Previously, I tested positive for H.
pylori during an endoscopy, but I was treated and cleared of it.
However, I also underwent a colonoscopy due to IBS, where two benign polyps were found and removed.
These experiences are in the past, and I know the discomfort associated with endoscopy and colonoscopy (which requires fasting and taking laxative-like medication), so I prefer to avoid them.
I must apologize to you, Doctor! Due to my mental illness and limited clinic hours, I forgot to ask the gastroenterologist today.

(1) I have moderate fatty liver, and it has been a long-standing condition.
Why hasn’t it progressed to cirrhosis or cancer? Generally, fatty liver indicates liver inflammation.
How long should I wait for a follow-up appointment regarding moderate fatty liver?
(2) Sometimes, when I cannot find a restroom, I feel anxious and frequently pass gas.
I also often pass gas at home, and I am unsure if I need to undergo any tests.
Occasionally, when urinating, I accidentally expel a small amount of watery stool as well! How can I improve this situation?
(3) During today’s ultrasound, the doctor mentioned that there are sandy conditions in my gallbladder! They advised me to avoid sweets, fried foods, and to exercise more.
Previously, my gallbladder did not have this condition; how can I restore it to normal? If my gallbladder becomes severely affected in the future and needs to be removed, what will happen? Will it be a permanent solution? Thank you very much for your patience in reading this.

Jason, 40~49 year old female. Ask Date: 2020/11/13

Dr. Lin Minghui reply Gastroenterology and Hepatology

Hello, fatty liver refers to the accumulation of fat in liver cells, which may sometimes cause fluctuations in liver enzyme levels, but typically involves minimal liver fibrosis.
Once it progresses to non-alcoholic steatohepatitis (NASH), the liver may exhibit inflammation or fibrosis, similar to chronic hepatitis B, which can lead to cirrhosis or liver cancer after 20-30 years.
It is recommended to follow up every six months, focus on weight loss, and control diet and exercise to prevent simple fat accumulation from progressing to hepatitis and fibrosis.
Regarding irritable bowel syndrome (IBS) or anxiety, symptoms such as gas, urination, and bowel movements may occur simultaneously.
This could be related to dysregulation of the autonomic nervous system.
It is advisable to reduce intake of greasy and sugary foods, be cautious with dairy products, and develop healthy eating habits.
Identifying sources of stress and finding ways to alleviate it is also important.
Colon polyps should be monitored.
Excess cholesterol and bilirubin in bile, along with insufficient emptying of the gallbladder, can lead to the formation of sludge or stones.
For gallbladder sludge or stones, a regular diet low in greasy and sugary foods, along with adequate hydration, is recommended.
Most gallstones are asymptomatic and do not require treatment; however, if there is frequent pain after meals or complications such as cholecystitis or pancreatitis, gallbladder removal may be necessary.
Bile duct stones can be managed with endoscopic stone removal.
Bile is secreted by the liver, and the gallbladder serves as a storage site for bile.
When the intestines need bile to aid in fat digestion, it is delivered to the duodenum via the bile ducts.
After gallbladder removal, digestion of fatty foods may become more challenging.
It is important to avoid greasy foods, as prolonged accumulation of bile can lead to bile duct stones and obstruction.
Bile duct stones or obstructions can be addressed using endoscopic techniques.
Wishing you peace and health!
Dr.
Ming-Hui Lin, Attending Physician, Gastroenterology Department, Taoyuan General Hospital, Ministry of Health and Welfare.

Reply Date: 2020/11/13

More Info

Managing fatty liver and gastrointestinal issues can be quite challenging, especially when compounded by lifestyle choices and underlying health conditions. Your situation reflects a common struggle faced by many individuals dealing with similar health concerns. Let's address your questions one by one, providing insights based on medical knowledge and best practices.

1. Fatty Liver and Its Progression
You mentioned having moderate fatty liver for an extended period without progression to cirrhosis or cancer. This is a positive sign, as fatty liver disease can often be reversible, especially in its early stages. The liver has a remarkable ability to regenerate and heal itself, provided that the underlying causes are addressed. Factors such as obesity, excessive alcohol consumption, and metabolic disorders contribute to the progression of fatty liver disease.
In your case, maintaining a healthy weight and making dietary changes are crucial. Regular follow-ups with your healthcare provider are essential, typically every 6 to 12 months, depending on your liver function tests and ultrasound findings. Your doctor may recommend lifestyle modifications, including a balanced diet low in sugars and saturated fats, and regular physical activity, which can significantly improve liver health.

2. Gastrointestinal Symptoms and Anxiety
Your gastrointestinal symptoms, including gas and occasional incontinence, may be linked to anxiety and dietary choices. Anxiety can exacerbate gastrointestinal issues, leading to symptoms like bloating and increased gas production. It’s essential to manage stress through relaxation techniques, mindfulness, or therapy, especially since you have a history of mental health challenges.

Dietary habits also play a significant role in gastrointestinal health. Foods high in fiber can help regulate bowel movements and reduce gas. However, certain foods, such as beans, carbonated beverages, and high-fat meals, can contribute to gas and bloating. Keeping a food diary may help identify specific triggers.

If your symptoms persist or worsen, it may be beneficial to consult a gastroenterologist for further evaluation. They can recommend tests to rule out conditions like irritable bowel syndrome (IBS) or food intolerances.

3. Gallbladder Health and Dietary Recommendations
The presence of gallbladder sludge or "sand" can indicate a risk for gallstones, especially if you have a history of dietary indiscretions. The gallbladder plays a crucial role in fat digestion, and a diet high in saturated fats and sugars can lead to the formation of gallstones.
To improve gallbladder health, focus on a diet rich in fruits, vegetables, whole grains, and lean proteins. Avoiding fried foods, excessive sugars, and refined carbohydrates is essential. Regular exercise can also help maintain a healthy weight and improve gallbladder function.

If gallbladder issues become severe, surgical removal (cholecystectomy) may be necessary. While this procedure can alleviate symptoms and prevent complications, it’s important to note that the gallbladder is not essential for digestion. Many people live healthy lives without it, but they may need to adjust their diets post-surgery to accommodate the changes in fat digestion.

Conclusion
In summary, managing fatty liver and gastrointestinal issues requires a multifaceted approach that includes dietary changes, regular medical follow-ups, and stress management. It’s crucial to work closely with your healthcare provider to monitor your liver health and address any gastrointestinal symptoms. By making informed lifestyle choices and seeking appropriate medical care, you can significantly improve your overall health and well-being. Remember, gradual changes are often more sustainable and effective in the long run.

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