Liver Disease Often Has No Warning Signs. A Specialist Explains Why That Makes Screening So Critical

Most people never think about their liver until something goes wrong. That silence, according to Stevan Gonzalez, M.D., M.S., director of liver transplantation at Baylor Scott & White Health, is exactly the problem.

Gonzalez, who spoke at the 2026 Liver Health Symposium hosted by the Global Liver Institute, made the case for a fundamental shift in how Americans think about liver health. The liver, he explained, is one of the body’s most vital and most resilient organs, working continuously and without complaint every single day. But that resilience has a dark side.

“The liver is a vital organ that is continuously working for us every single day, but it’s silent,” Gonzalez said. “We don’t see our liver, we don’t feel our liver, and so if a person has a chronic liver disease, the liver is actually a very resilient organ that will continue doing that work every single day, without any complaints, without any symptoms.”

That silent injury can lead to scar tissue in the liver, a process known as fibrosis, over time. By the time a person feels something is wrong, the damage may already be significant, which is why Gonzalez stressed the importance of routine follow-up with a primary care physician and proactive screening for anyone with risk factors.

The Two Biggest Drivers of Liver Disease in the U.S.

Gonzalez identified the two leading causes of liver disease in the United States as alcohol-associated liver disease and metabolic dysfunction-associated steatotic liver disease, or MASLD, the condition most people know as fatty liver disease. MASLD is closely tied to diabetes and obesity, making diet and physical activity two of the most powerful tools available for prevention.

Alcohol-associated liver disease has seen a troubling rise, particularly since the COVID-19 pandemic, and the burden is not falling evenly. “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 noted. “They have had a significant increase in alcohol-associated liver disease, more than in the past.”

Why Screening Is So Critical

Because liver disease so rarely announces itself through symptoms, routine screening is one of the most powerful tools available for catching it early. Gonzalez pointed to hepatitis C as a clear example. It is a silent infection that can cause years of liver damage with no outward signs, yet it is also curable with treatments that are highly effective and well tolerated. Current guidelines recommend that every adult in the United States be screened for hepatitis C at least once, something that can be done through a primary care office visit.

“We have to think about the liver in a different way because there’s no outward signs in most cases,” he said.

What You Can Do Right Now

Gonzalez was direct about the scale of the problem. “What we’re recognizing is that chronic liver disease in the U.S. is vastly underestimated,” he said, adding that addressing it will require more than specialists working in isolation. Primary care providers and community health organizations, he argued, will play an essential role in expanding awareness, education and screening at the population level.

For patients without regular access to a physician, Gonzalez encouraged exploring local community health fairs and organizations. The Global Liver Institute itself conducted liver disease screening on site at the symposium, a model he said advocates are working to replicate nationwide.

His advice to patients was simple and direct: Ask your primary care doctor whether liver screening makes sense for you. Follow a low-fat diet, exercise regularly, maintain a healthy weight and be mindful of alcohol use. And above all, do not wait for symptoms.

“You have to explore your own community to see what’s available,” he said. “But it’s really based on community efforts.”