Table 1

Summary of published community pathways for detection of liver disease in the UK

PathwayLFT or risk factorInput from Primary CareNext stepsOutcome
Camden and Islington NAFLD Pathway25 LFTCalculate FIB-4 after clinically diagnosing NAFLD (based on elevated ALT, non-harmful alcohol use±steatosis on US)If FIB-4 elevated, patient referred to secondary care; if FIB-4 indeterminate, GP then performs ELFIf ELF elevated, refer to secondary care
Gateshead Project28 Risk factorFIB-4 calculated at routine diabetic clinicIf FIB-4 elevated, GP refers for TEPatients with abnormal TE referred to secondary care
Gwent AST Project24 LFTRequest LFTsAutomated reflex AST with AST:ALT ratio calculationIf AST:ALT ratio≥1, direct access to TE provided
Intelligent liver function testing (iLFT)23 LFTRequest LFTs and provide BMI, alcohol intake and comorbidities at time of requestAutomated reflex testing of full aetiological liver screen with non-invasive fibrosis scores and ELF where indicated32 individual outcomes detailing likely aetiology, stage of fibrosis and management plan including if/when to refer to secondary care
Leeds Community Hepatology Pathway (CHEP)29 LFT and risk factor (‘GP suspicion’)Perform ELF in patients with suspected CLDIf ELF elevated, GP refers for community TEIf TE elevated, specialist review
Scarred Liver Project26 Risk factorComplete algorithm for patients at riskIf meet criteria, patient referred directly for TEAll patients provided with liver health information from British Liver Trust; patients with abnormal TE referred to secondary care
  • ALT, alanine aminotransferase; AST, aspartate aminotransferase; BMI, body mass index; CLD, chronic liver disease; ELF, enhanced liver fibrosis; FIB-4, Fibrosis-4; LFT, liver function test; NAFLD, non-alcoholic (metabolic) fatty liver disease; TE, transient elastography.