Dr Harriet Gordon, Consultant Hepatologist, Hampshire Hospitals FT and member of the Equally Well UK Clinical Group
Liver disease is a major cause of death and, unlike heart disease, cancer and stroke, cases are increasing every year. There are a number of causes of liver disease, but the most common can often be prevented with help, for example support with alcohol misuse, diabetes and healthy weight management. 25% of the population is considered obese and at risk of non-alcoholic fatty liver disease, which can cause scarring and lead to cirrhosis. There are established relationships between severe mental illness and alcoholic liver disease and between drug abuse and hepatitis B and C. After alcohol, the second most common cause of liver disease in the UK is metabolic syndrome (the combination of diabetes and obesity), which is also more prevalent in people with mental illness and people who take psychotropic drugs than in the general population. Psychiatric disorders may also preclude access to liver transplant.
The main difficulty with liver disease is that there are often no signs and symptoms until the disease is in a late stage. It may often not be diagnosed until the person is admitted to hospital with very late-stage cirrhosis. The average age of someone dying from liver disease is sadly 58.
There has however been a lot of work to look for ways of identifying liver disease earlier, when changes can reverse the liver damage. Across the UK most regions are screening those at risk, particularly people with diabetes, obesity and known alcohol problems. The results of initial blood tests are added to a formula which includes the person’s age. This can help identify people who might be at risk of liver disease. They are then invited for a liver elastography scan. This is a type of ultrasound scan which is painless and measures how wobbly the liver is. A normal liver is wobbly, like a jelly, but with liver damage comes scarring and the liver becomes harder, and this can be picked up on the scan. The scan takes a few minutes, and the result is immediately available.
In Mid Hampshire we have been working on a project where all scanning is done using a portable scanner and takes place in GP practices, rather than in hospitals. We have found it most helpful to those attending diabetes clinics and other services that the scan can be arranged in the GP surgery. The person can then be referred on to the hospital if needed following the liver elastography scan. In this way we have been able to see people in hospital who feel well and would never have known they had a problem, but who actually have liver fibrosis or cirrhosis. We can then focus treatment on limiting damage and screening for further problems.
This project has attracted interest nationally and features as an example of good practice in the latest Lancet Commission into the earlier detection of liver disease.