Chronic Liver Disease: How PCPs Can Improve Early Detection

Since chronic liver disease often presents with "silent" symptoms, improving early detection requires support beyond hepatologists; primary care clinicians and community-based health organizations can develop their role in increasing awareness and expanding screening efforts.

“We're recognizing that chronic liver disease in the US is vastly underestimated, and it's beyond what a liver specialist can do in terms of the general population,” Steven Gonzalez, MD, MS, Director of Liver Transplantation at Baylor Scott & White Health, said in an interview with HCPLive to discuss his talk from the 2026 Liver Health Symposium, hosted by the Global Liver Institute. “That's where our primary care providers and our community-based health organizations are going to play a very important role in increasing awareness, education, and screening.”

How Much of the US is Impacted by Chronic Liver Disease?

According to the Centers for Disease Control and Prevention (CDC), chronic liver disease is the 9th leading cause of death in the United States. In total, 1.8% of adults ≥ 18 years of age have been diagnosed with liver disease, standing at 4.5 million individuals. Furthermore, an estimated 33% of US adults have metabolic dysfunction-associated steatotic liver disease (MASLD), while cirrhosis impacts around 2.6% of the population.

Why Don’t More Patients Know They Have Liver Disease?

As Gonzalez explains, the liver is a “resilient” organ.

As such, one of the greatest challenges is that chronic liver disease often progresses without noticeable symptoms. Since the liver can continue functioning despite ongoing injury, patients may live with inflammation and fibrosis for years or even decades before receiving a diagnosis.

By the time cirrhosis develops, the liver has often sustained irreversible scarring. At that stage, patients may begin experiencing fatigue, nausea, unintentional weight loss, or mild cognitive impairment.

The American Liver Foundation emphasizes that early intervention, whether through alcohol cessation, treatment of viral hepatitis, or management of obesity and metabolic disease, can halt disease progression and, in some patients, reverse early-stage liver damage before irreversible scarring develops.

One reason many cases go undetected is that routine laboratory testing does not specifically screen for liver fibrosis. Liver enzyme testing, fibrosis assessments, and imaging are often performed only after clinicians suspect underlying liver disease or identify patients at increased risk

What Characteristics Should Clinicians Look Out For in Chronic Liver Disease?

In recent years, rates of chronic liver disease, particularly alcohol-associated liver disease (ALD) and MASLD, have increased.

“There are groups of populations in the U.S. who are disproportionately affected by alcohol-associated liver disease, and that includes women, younger people, and Native Americans.”

Gonzalez said addressing the growing burden of chronic liver disease will require a broader public health approach, with primary care clinicians, community organizations, and hepatologists working together to identify at-risk patients before irreversible liver damage occurs. Earlier screening, patient education, and timely referral, he noted, may represent the greatest opportunity to reduce the long-term impact of chronic liver disease.

Editor’s Note: Gonzalez reports relevant disclosures with Mallinckrodt Pharmaceuticals, Salix, AbbVie, Gilead, and others.

References

1. Centers for Disease Control and Prevention. FastStats. CDC. Published October 11, 2019. Accessed July 10, 2026. https://www.cdc.gov/nchs/fastats/liver-disease.htm

2. Hazeldine S, Hydes T, Sheron N. Alcoholic liver disease – the extent of the problem and what you can do about it. Clinical Medicine. 2015;15(2):179-185. doi:10.7861/clinmedicine.15-2-179

3. Paik JM, Shah D, Eberly K, Golabi P, Henry L, Younossi ZM. Changes in mortality due to Chronic Liver Diseases (CLD) during the COVID-19 pandemic: Data from the United States” National Vital Statistics System. PloS one. 2024;19(9):e0289202. doi:10.1371/journal.pone.0289202