Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2022 Jan 24;13(5):367-373.
doi: 10.1136/flgastro-2021-101833. eCollection 2022.

Identification of liver disease: why and how

Iain Macpherson  1   2 , Kushala W M Abeysekera  3 , Rebecca Harris  4 , Dina Mansour  5   6 , Stuart McPherson  6   7 , Ian Rowe  8   9 , William Rosenberg  10   11 , John F Dillon  1   2 , Andrew Yeoman  12 ; Specialist Interest Group in the Early Detection of Liver Disease Members
Collaborators, Affiliations
Review

Identification of liver disease: why and how

Iain Macpherson et al. Frontline Gastroenterol. .

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.

Keywords: chronic liver disease; liver function test; primary care; screening.

PubMed Disclaimer

Conflict of interest statement

Competing interests: KWMA has received lecture fees from Intercept Pharma and a grant from the David Telling Charitable Trust unrelated to this work, DM has received consultancy fees from Intercept Pharma unrelated to this work, SM has received personal fees from MSD, AbbVie and Gilead unrelated to this work, IR has received consultancy fees from Roche unrelated to this work, WR has received speakers fees and research support from Siemens Healthineers unrelated to this work, and is an inventor of the Enhanced Liver Fibrosis Score but has not received royalties in this regard. No other authors have any competing interests related to this work.

Figures

Figure 1
Figure 1
iLFT pathway. BMI, body mass index; iLFT, intelligent liver function testing; LFT, liver function test.
See this image and copyright information in PMC

References

    1. Williams R, Aspinall R, Bellis M, et al. . Addressing liver disease in the UK: a blueprint for attaining excellence in health care and reducing premature mortality from lifestyle issues of excess consumption of alcohol, obesity, and viral hepatitis. Lancet 2014;384:1953–97. 10.1016/S0140-6736(14)61838-9 - DOI - PubMed
    1. British Liver Trust . The alarming impact of liver disease in the UK: facts and statistics. United Kingdom, 2019.
    1. Cancer research UK. Available: https://www.cancerresearchuk.org/health-professional/cancer-statistics/m...
    1. Burton A, Tataru D, Driver RJ, et al. . Primary liver cancer in the UK: incidence, incidence-based mortality, and survival by subtype, sex, and nation. JHEP Rep 2021;3:100232. 10.1016/j.jhepr.2021.100232 - DOI - PMC - PubMed
    1. Public Health England . Liver disease profiles: short statistical commentary, 2018.

LinkOut - more resources