Over the last decade, UK deaths from liver disease have soared by 40%. It is the only major cause of mortality and morbidity that is increasing in England. Meanwhile, in some European countries, liver disease deaths have reduced by 45%. What is the UK doing wrong

“A report recently released by Public Health England identifies the cause of the rise – and it is, in effect, poverty and lack of adequate information,” says Professor Massimo Pinzani, Professor of Medicine, clinical hepatologist, Director of the UCL Institute for Liver and Digestive Health and the Sheila Sherlock Chair of Hepatology at UCL.

The PHE data reveals stark inequalities: the rate of people dying early from liver disease in some parts of England is almost eight times higher than in others. In the most deprived fifth of the country, people with liver disease die nine years earlier than those in the most affluent fifth.

Moreover, people are dying of liver damage younger - the average age of death is now in the mid-50s.

 

Most causes are preventable

 

Ironically, the vast majority of liver disease is preventable. Three major risk factors - alcohol, obesity and Hepatitis B and C – account for the large majority of cases. “People with viral hepatitis B and C who live in areas with less effective NHS primary care consequently end up in hospital with advanced chronic liver disease,” says Pinzani.

“Meanwhile fatty liver disease, associated with obesity, and alcohol-related liver disease are on the increase and we are seeing increased demand for liver transplants for people in their 20s.”

The number of deaths from liver disease also includes about 30-40% of patients with liver cirrhosis developing liver cancer, which greatly accelerates the progression to liver failure.

Others die from other conditions caused by cirrhosis, such as bleeding varices. These are dilated blood vessels in the oesophagus or stomach, resulting from high blood pressure caused when blood is diverted from the damaged liver. There are treatments for varices, but if they rupture and bleed, it can be life-threatening. 

 

Calling for action

 

An experimental project supported by the British Association for the Study of the Liver is planning preventive action. The plan is to provide GPs in selected areas with a Fibroscan device, which can detect non-invasively the presence of cirrhosis in its early stages,” says Pinzani.

He also hails the addition of hepatitis B to the six-in-one vaccination which is routinely offered to all new-borns, due to start this month.

“We also need to find a treatment that kills the hepatitis B virus. Current treatments repress its effects, but do not eliminate it. New antiviral treatments that completely eradicate the hepatitis C virus are being rolled out now, starting with patients who have the most advanced disease. Treatment will gradually be extended to those at earlier stages so that should avoid them developing cirrhosis.

“We need to find treatments that deliver the same results for hepatitis B.”