Clinical hepatology: profile of an urban, hospital-based practice

Abstract

To dispel the common notion that the practice of hepatology in North America largely consists of the care of middle-aged male patients with alcohol-induced liver disease, and, in the process, provide undergraduate and postgraduate students with a clearer picture of what patient profiles might resemble in an urban, hospital-based hepatology practice, 1,226 charts derived from referrals between July 1, 1987, and January 1, 1994, were retrospectively reviewed for the following information: year of referral, age and sex of the patient, practice of the referring physician, status of ongoing care, and principal diagnosis. The results of the study revealed the following: 1) referrals for assessment and care of patients with liver disease are increasing at a rapid rate, 2) the majority of referred patients are between the ages of 25 and 45 years, 3) there is an equal distribution of men and women, 4) referrals are most often from general practitioners (57%) and internists (27%), 5) turnover is common, with 56% of referred patients no longer being followed, and 6) a variety of liver disorders are seen, including acute and chronic viral hepatitis (47%), nonalcoholic steatohepatitis (11%), drug-induced liver disease (6%), alcoholic liver disease (5%), primary biliary cirrhosis (4%), primary sclerosing cholangitis (3%), autoimmune chronic hepatitis (3%), "cryptogenic" cirrhosis (3%), and miscellaneous or undiagnosed causes (20%). Thus, contrary to popular belief, in this urban, hospital-based practice, the majority of liver disease patients are not middle-aged alcoholics, but rather young adults with a variety of hepatobiliary disorders.