Liver disease has no symptoms in the early stages. Sadly, the means that many patients are diagnosed at a later stage when their condition has deteriorated and treatment options are limited.
People with liver disease have better outcomes when they’re diagnosed early. In some parts of the UK, patients are invited for a liver scan, using a method called transient elastography, to identify signs of liver damage before they progress. They are also given liver health advice at this appointment.
However, how frequent these appointments should be, and how effective the health information is, are both uncertain.
The LOCATE study, led by Tina Reinson, a researcher at the University of Southampton, looked at how effective this approach is at preventing progression of liver disease in primary care. The study was funded by the British Liver Trust and Solent NHS Trust.
What happened in the study?
Researchers invited patients across five GP surgeries in Southampton to a liver scan and health advice appointment. They asked them questions about how much alcohol they drank, measured their weight and scanned their livers with transient elastography.
Four and a half years later, patients were invited back for a follow-up appointment. Researchers looked at how many patients returned for a second scan, and if they did, how the patients’ liver health had changed over time. They also measured their weight and how much alcohol they were drinking.
What did the study find?
Only half of those eligible came back for a follow up scan. Nearly one in five (19%) of the people rescanned showed signs that their liver health had deteriorated since their initial appointment. Overall the study found that patients were drinking more alcohol and had only very slightly decreased their weight.
In summary, further support than what is currently available in primary care is needed to help patients make lifestyle changes for better liver health. With additional resources, primary care can play an important role in helping patients to make positive and sustainable lifestyle changes.
This does not have to increase the workload of primary care doctors. For example, in Southampton there is a community liver service for GPs to refer patients to if they suspect they may have liver disease.
Importantly, scan data from the study suggested that patients identified with intermediate liver scarring (fibrosis) are at moderate risk of their condition getting worse, and robust follow-up and engagement is needed to maintain contact with them. Even if there are no specific factors that suggest a patient will quickly progress from mild scarring to advanced scarring and cirrhosis, doctors should manage patients on the presumption that their liver disease will progress.