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Opinion
#FGDebate: Should we focus on detecting patients at risk of liver disease in the community?
  1. Kushala WM Abeysekera1,
  2. Jessica Shearer2,
  3. Oliver D Tavabie3,
  4. John F Dillon4,
  5. Ian A Rowe5
  1. 1Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
  2. 2Leeds Liver Unit, St James’s University Hospital, Leeds, UK
  3. 3The Sheila Sherlock Liver Centre, Royal Free Hospital, London, UK
  4. 4Division of Clinical and Molecular Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
  5. 5Leeds Institute for Medical Research, University of Leeds & Leeds Liver Unit, St James's University Hospital, Leeds, UK
  1. Correspondence to Dr Oliver D Tavabie, Royal Free Hospital, London, UK; oliver.tavabie{at}nhs.net

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Introduction

The #FGDebate series featured ‘Controversies in detecting patients with liver disease’ which was inspired by the recent review from Macpherson et al.1 The debate was well attended and generated 1.35 million impressions across Twitter, which placed it within the top 10 #FGDebate of all time for total impressions made. The main topic for debate was whether we should focus on detecting patients at risk of liver disease in the community. Here, we aim to provide arguments for and against this issue.

Pro

What is the landscape our patients find themselves in? Liver disease is a major cause of morbidity in the UK and one of the leading causes of death in 35–49 years.2 The national trainee collaborative, ToRcH-UK, involving 1168 patients with decompensated liver disease, across 104 acute trusts in UK, demonstrated 1 in 6 inpatients died during their admission.3 Over 70% of new liver disease presents acutely to hospital, many dying without the chance to change.4

The aim must be to reduce morbidity and mortality from liver disease. The two major leading causes of this are alcohol-related liver disease (ArLD) and non-alcoholic fatty liver disease (NAFLD), both preventable liver diseases with early intervention. Detecting liver disease early to facilitate specialist input, lifestyle and pharmacological interventions, may provide a genuine opportunity to prevent patients developing decompensated cirrhosis and hepatocellular carcinoma. While we lack prospective data, focusing on identification of patients with advanced fibrosis (ie, ≥F3 fibrosis), and thus at greater risk of future decompensating events, provides patients with the control to make supported lifestyle changes. For example, informing patients with alcohol misuse they have liver injury has been shown to trigger a substantial reduction in weekly alcohol consumption.5 By detecting and managing advanced fibrosis early, we can reduce admissions and mortality from liver disease while alleviating the …

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Footnotes

  • KWA and JS are joint first authors.

  • JFD and IAR are joint senior authors.

  • Contributors All authors contributed to conceptualisation of the manuscript. KWMA drafted the Pro section under the supervision of JFD, JS drafted the Con section under the supervision of IAR, ODT drafted the introduction and conclusion. All authors reviewed and edited the manuscript and approved the final version.

  • 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 ODT is a Trainee Associate Editor at Frontline Gastroenterology. All other declare no conflicts in interest.

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