Liver diseases often go undetected; doctors call for early screening and awareness

An estimated 304 million people worldwide live with chronic hepatitis B or C, according to the World Health Organization (WHO). Of these, 254 million have hepatitis B and 50 million have hepatitis C. The disease causes about 1.3 million deaths annually over 3,500 each day. India accounts for over 11.6% of the global burden, with around 29.8 million people living with hepatitis B and 5.5 million with hepatitis C.

Hepatitis is inflammation of the liver, most commonly caused by viral infections, mainly hepatitis A, B, C, D, and E. Among these, hepatitis B and C can become chronic, potentially leading to cirrhosis, liver failure or cancer. Transmission can occur through unsafe injections, blood transfusions, sexual contact or from mother to child during childbirth.

Despite the scale, most infections remain undiagnosed until complications arise. Doctors say this is due to vague early symptoms, inadequate screening, and widespread misconceptions.

“In the early stages, liver trouble may show up as fatigue, appetite loss or mild abdominal pain – symptoms that are easily overlooked,” said Vivekanandan Shanmugam, Lead Liver Transplant Surgeon, SIMS Hospital, Chennai . “Even signs like dark urine or yellowing of the eyes are ignored. As a result, patients often present late.”

He added that screening for hepatitis B and C is recommended for high-risk groups – those who had blood transfusions before the 1990s, dialysis patients and healthcare workers, but implementation remains patchy. “Many people don’t know they should get tested. There is stigma and poor access, especially in peripheral areas,” he said.

Dr. Shanmugam also flagged the impact of over-the-counter painkillers and unregulated herbal supplements. “The liver filters everything we consume. Long-term misuse of common drugs like paracetamol or herbal concoctions can silently damage the liver.”

Radhika Venugopal, Senior Consultant – Hepatology, Liver Disease & Transplantation, Rela Hospital, Chennai, said symptoms such as nausea, fatigue, or weight loss are often ignored. “By the time jaundice, swelling or bleeding appears, damage is usually advanced. Liver function tests and scans can help detect problems early,” she said.

She noted that hepatitis testing is not well integrated into routine healthcare, particularly in rural settings. “Pregnant women, people with HIV, and those undergoing surgery or dialysis must be screened, but enforcement is weak.”

Dr. Venugopal also flagged the rise in “lean MAFLD” (metabolic-associated fatty liver disease) in people with normal weight but underlying metabolic issues. “Tools like FibroScan help detect this early.”

Doctors recommend hepatitis B vaccination, avoiding excessive alcohol, limiting self-medication, and routine check-ups. “The liver is silent until it’s too late,” said Dr. Shanmugam.