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Care standards for non-alcoholic fatty liver disease in the United Kingdom 2016: a cross-sectional survey
  1. David A Sheridan1,
  2. Guru Aithal2,
  3. William Alazawi3,
  4. Michael Allison4,
  5. Quentin Anstee5,
  6. Jeremy Cobbold6,
  7. Shahid Khan7,
  8. Andrew Fowell8,
  9. Stuart McPherson9,
  10. Philip N Newsome10,11,
  11. Jude Oben12,
  12. Jeremy Tomlinson13,
  13. Emmanouil Tsochatzis14
  1. 1Institute of Translational and Stratified Medicine, Plymouth University, Plymouth, UK
  2. 2Biomedical Research Unit, NIHR Nottingham Digestive Diseases, Nottingham, UK
  3. 3Queen Mary, University of London and Bart's Health NHS Trust, London, UK
  4. 4Biomedical Research Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, UK
  5. 5Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
  6. 6John Radcliffe, Oxford University Hospitals NHS Trust, Oxford, UK
  7. 7Imperial College Healthcare NHS Trust
  8. 8Portsmouth Hospitals NHS Trust, Portsmouth, UK
  9. 9Newcastle upon Tyne Hospitals NHS Trust
  10. 10National Institute for Health Research (NIHR) Birmingham Liver Biomedical Research Unit and Centre for Liver Research, University of Birmingham, Birmingham, UK
  11. 11Liver Unit, Queen Elizabeth University Hospital Birmingham, Birmingham, UK
  12. 12University College London, and Guys and St Thomas’ NHS Foundation Trust, London, UK
  13. 13Oxford Centre for Diabetes, Endocrinology & Metabolism, Oxford University, Oxford, UK
  14. 14Institute for Liver and Digestive Health, Division of Medicine, University College London and Royal Free Hospital, NHS Foundation Trust, London, UK
  1. Correspondence to Dr David Sheridan, Institute of Translational and Stratified Medicine, Plymouth University, Plymouth PL6 8BU, UK; david.sheridan{at}


Objective Guidelines for the assessment of non-alcoholic fatty liver disease (NAFLD) have been published in 2016 by National Institute for Health and Care Excellence and European Associations for the study of the Liver–European Association for the study of Diabetes–European Association for the study of Obesity. Prior to publication of these guidelines, we performed a cross-sectional survey of gastroenterologists and hepatologists regarding NAFLD diagnosis and management.

Design An online survey was circulated to members of British Association for the Study of the Liver and British Society of Gastroenterology between February 2016 and May 2016.

Results 175 gastroenterologists/hepatologists responded, 116 completing the survey, representing 84 UK centres. 22% had local NAFLD guidelines. 45% received >300 referrals per year from primary care for investigation of abnormal liver function tests (LFTs). Clinical assessment tended to be performed in secondary rather than primary care including body mass index (82% vs 26%) and non-invasive liver screen (86% vs 32%) and ultrasound (81% vs 37%).Widely used tools for non-invasive fibrosis risk stratification were aspartate transaminase (AST)/alanine transaminase (ALT) ratio (53%), Fibroscan (50%) and NAFLD fibrosis score (41%). 78% considered liver biopsy in selected cases. 50% recommended 10% weight loss target as first-line treatment. Delivery of lifestyle interventions was mostly handed back to primary care (56%). A minority have direct access to community weight management services (22%).Follow-up was favoured by F3/4 fibrosis (72.9%), and high-risk non-invasive fibrosis tests (51%). Discharge was favoured by simple steatosis at biopsy (30%), and low-risk non-invasive scores (25%).

Conclusions The survey highlights areas for improvement of service provision for NAFLD assessment including improved recognition of non-alcoholic steatohepatitis in people with type 2 diabetes, streamlining abnormal LFT referral pathways, defining non-invasive liver fibrosis assessment tools, use of liver biopsy, managing metabolic syndrome features and improved access to lifestyle interventions.


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  • Contributors DAS designed the survey, collated responses, performed data analysis and wrote first draft of the manuscript. GA, WA, MA, QA, JC, SK, AF, SM, PNN, JO, JT and ET contributed to the design of the survey, interpretation of data and revised the manuscript.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.