• fatty liver
• alcoholic liver disease
• primary care

The rising prevalence of alcohol-related liver disease (ARLD) and non-alcoholic fatty liver disease (NAFLD) presents a challenge to gastroenterology and hepatology departments. Traditional referral practices from primary care based on raised liver function tests alone can lead to a significant number of referrals of patients without significant liver disease, leading to overdiagnosis and adding to pressure on outpatient services and associated increased costs.1 Moreover, such referral practices may fail to identify patients with serious liver disease, as it is well known that advanced fibrosis and cirrhosis can be associated with normal liver function tests.

In Frontline Gastroenterology, Chalmers et al present findings from a commissioned referral pathway designed to focus on risk factors for NAFLD or ARLD rather than abnormal liver enzymes alone.2 Under the pathway, general practitioners (GPs) were encouraged to identify patients at risk of significant liver disease and to refer these patients for assessment with transient elastography (TE). Patients with a TE reading suggesting significant liver fibrosis (TE >8 kPA) were recommended to be referred for assessment in secondary care, whereas those with lower readings underwent a brief intervention regarding lifestyle by a dedicated nurse in …