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Identification of liver disease: why and how
We are all aware that mortality from chronic liver disease (CLD) in the UK has increased by over 400% since 1970, driven by alcohol, non-alcoholic fatty liver disease and hepatitis C virus, the natural histories of which can all be improved by early intervention. In this issue MacPherson and colleagues discuss the key issues. Patients most often present with advanced liver disease – often with decompensated cirrhosis. 90% of chronic liver disease is caused by reversible and avoidable factors. Early diagnosis gives the potential for early intervention. This includes ‘best use’ of community identification pathways – discussed in detail in the paper. Liver function tests are frequently measured although the majority of abnormal results not fully investigated. Risk stratification strategies for more intensive testing are based on liver function test results, identification of at-risk populations and a combination of both. The intent is to make diagnoses earlier with the best use of available resources including indications for and practicalities of fibrosis assessment. The authors discuss some principles which, if adopted, are likely to improve the diagnosis of advanced liver disease, and identify the areas of contention for further research, in order to establish the most effective community detection models of liver disease. They finish with a helpful list of research recommendations. Important reading. Editor’s Choice this month (See page 367) .
Improved outcomes following the implementation of a decompensated cirrhosis discharge bundle
Management of decompensated cirrhosis (DC) is inconsistent across the UK. Patients have complex …
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; internally peer reviewed.