Professor John Dillon
Consultant Hepatologist, Professor of Hepatology and Gastroenterology, University of Dundee Vice-President for Hepatology, British Society of Gastroenterology
Rates of liver disease are increasing across the United Kingdom. It is a rapidly rising cause of death in those under the age of 65.
Since 1970, there has been between a 400-500% increase in the mortality rates for liver disease. This is in a stark contrast to most other diseases where the mortality rates have stayed stable or fallen in the same time period.
Liver disease is in many ways a sneaky killer, people are unaware that they have the disease until it’s too late. Most people are often first aware that they have the problem when they present to hospital, with a severe complication such as internal bleeding or the development of massive fluid in the abdomen.
The most common causes of liver disease in the UK – which are also preventable – are related to excess alcohol consumption, chronic viral hepatitis or obesity related fatty liver disease. All three cause chronic low-grade damage to the liver where it is progressively replaced with fibrosis leading to cirrhosis.
Liver disease is in many ways a sneaky killer, people are unaware that they have the disease until it’s too late.
Importance of liver function tests
This development of liver disease is even more surprising given that one of the common blood tests performed on people are liver function tests. Most adults in the UK have had them at least once. The blood test is very simple and commonly taken within general practice.
However, the interpretation of these blood tests is complex as liver disease will often only cause minor abnormalities, despite leading to serious complications. These abnormalities are difficult to detect but there are techniques which combine liver function tests with a mathematical formula to identify those at high risk of progressive scarring of the liver.
These mathematical calculations are not commonly available nor are they well understood by the average primary medical care provider.
Greater awareness and education needed
The British Society of Gastroenterology has highlighted members who have developed services that make these calculations routinely available to GPs to allow early detection of liver disease.
For example, in South Wales, there is the “Gwent Liver Pathway” and in Scotland “intelligent Liver Function Testing (iLFT)” where if GPs queried liver disease or requested liver blood tests they automatically have the additional calculations performed. The information is then provided back to GPs.
There are plans afoot to make this commonplace across the United Kingdom. We are hopefully entering a time in which liver disease is routinely and automatically detected early. This gives people an opportunity to avoid the dire consequences of liver disease, by changing lifestyle at an early stage.