Article Text
Abstract
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. Patients often present with advanced disease, which would be preventable if diagnosed earlier and lifestyle change opportunities offered.
Liver function tests (LFTs) are very commonly measured. Approximately 20% are abnormal, yet the majority are not investigated according to guidelines. However, investigating all abnormal LFTs to identify early liver disease would overwhelm services. Recently, several diagnostic pathways have been implemented across the country; some focus on abnormal LFTs and some on stratifying at-risk populations.
This review will collate the evidence on the size of the problem and the challenges it poses. We will discuss the limitations and restrictions within systems that limit the responses available, review the current pathways being evaluated and piloted in the UK, and explore the arguments for and against LFT-based approaches and ‘case-finding strategies’ in the community diagnosis of liver disease. Furthermore, the role of fibrosis assessment methods (including scoring systems such as Fibrosis-4 (FIB-4) index, the enhanced liver fibrosis test and elastography) within these pathways will also be discussed.
In conclusion, this review aims to establish 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.
- chronic liver disease
- screening
- liver function test
- primary care
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Footnotes
Twitter @drdina_mansour, @stumcp, @GwentLiverUnit
Collaborators Specialist Interest Group in the Early Detection of Liver Disease Members: John F Dillon, Andrew Yeoman, Kushala Abeysekera, William Alazawi, Richard Aspinall, Paul N Brennan, Johnny Cash, Matthew Cramp, Tim Cross, Kate Glyn-Owen, Fiona Gordon, Neil Guha, Rebecca Harris, Helen Jarvis, Moby Joseph, Iain Macpherson, Dina Mansour, Stuart McPherson, Joanne Morling, Philip Newsome, James Orr, Richard Parker, William Rosenberg, Ian Rowe, Ankur Srivastava, Leanne Stratton, Emmanouil Tsochatzis, Fidan Yousuf.
Contributors IM took the lead in writing the manuscript. All authors provided critical feedback and helped shape the research, analysis and manuscript.
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 KWMA has received lecture fees from Intercept Pharma and a grant from the David Telling Charitable Trust unrelated to this work, DM has received consultancy fees from Intercept Pharma unrelated to this work, SM has received personal fees from MSD, AbbVie and Gilead unrelated to this work, IR has received consultancy fees from Roche unrelated to this work, WR has received speakers fees and research support from Siemens Healthineers unrelated to this work, and is an inventor of the Enhanced Liver Fibrosis Score but has not received royalties in this regard. No other authors have any competing interests related to this work.
Provenance and peer review Commissioned; externally peer reviewed.
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