Purpose: Approximately 20 to 30 % of Indian population consume areca nut regularly. But, the studies relevant to its harmful systemic effects are scanty. Thus, the purpose of the present study was to assess danger of Hepatocellular carcinoma in areca nut habitual subjects by using ultrasonography, elastogrphy and liver enzyme analysis.
Methodology: This Institutional Ethics Committee approved case control study included 107 subjects, which were divided into control group and experimental group. The experimental group was further divided into two groups as only areca nut habitual and areca nut with Tobacco Habitual. All these subjects were assessed for habit history, clinical findings, liver status by ultrasonography, elastography and liver enzyme estimation. For ultrasonographic evaluation, Liver Surface, liver edge, and parenchymal echotexture were the three parameters used. For elastography, the validated criteria established by Castéra et al was used for measurements. (Fibro scan). The unit for Fibro scan readouts was kilopascal (kPa). The liver enzyme levels AST and ALT were also analyzed in all the participants.

Result: Based on US parameters, liver surface and liver edge showed Non-significant results While Parenchymal echotexture depicted Significant results. Fourteen (13.08%) revealed mild fibrosis and 2(1.87%) showed moderate fibrosis of liver. On the basis of elastography assessment, significant fibrosis was found in 15 (14.02%) subjects whereas 1 (0.93%) subject depicted severe fibrosis. Comparison of the three groups by using One way ANOVA showed significant results for both AST level and ALT levels. Fortunately, the features suggestive of liver cirrhosis or hepatocellular carcinoma are not found in any of the patients.

Conclusion: The diagnosis of liver fibrosis in 21% areca nut habitual, thosewere asymptomatic and thus unaware of their liver status should be considered asalarming one and needs a specific concern. Areca nut habitual subjects should beevaluated and treated for liver disease at its early stage, if present, to avert complications.