Clinical hepatology: Profile of an urban, hospital-based practic



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.