Identification of liver disease: why and how. Issue 5 (24th January 2022)

• Record Type: Journal Article
• Authors: Macpherson, Iain; Abeysekera, Kushala W M; Harris, Rebecca; Mansour, Dina; McPherson, Stuart; Rowe, Ian; Rosenberg, William; Dillon, John F; Yeoman, Andrew
• Other Names: author non-byline.; Dillon John F author non-byline.; Yeoman Andrew author non-byline.; Abeysekera Kushala author non-byline.; Alazawi William author non-byline.; Aspinall Richard author non-byline.; Brennan Paul N author non-byline.; Cash Johnny author non-byline.; Cramp Matthew author non-byline.; Cross Tim author non-byline.; Glyn-Owen Kate author non-byline.; Gordon Fiona author non-byline.; Guha Neil author non-byline.; Harris Rebecca author non-byline.; Jarvis Helen author non-byline.; Joseph Moby author non-byline.; Macpherson Iain author non-byline.; Mansour Dina author non-byline.; McPherson Stuart author non-byline.; Morling Joanne author non-byline.; Newsome Philip author non-byline.; Orr James author non-byline.; Parker Richard author non-byline.; Rosenberg William author non-byline.; Rowe Ian author non-byline.; Srivastava Ankur author non-byline.; Stratton Leanne author non-byline.; Tsochatzis Emmanouil author non-byline.; Yousuf Fidan author non-byline.
• Is Part Of: Frontline gastroenterology. Volume 13:Issue 5(2022)
• Page Start: 367
• Page End: 373
• Publication Date: 2022-01-24
• Subjects: chronic liver disease -- screening -- liver function test -- primary care; Gastroenterology -- Periodicals; 616.33005
• DOI: 10.1136/flgastro-2021-101833
• Languages: English
• ISSNs: 2041-4137

Abstract

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.