Early detection of liver disease by GPs ‘non-existent’

In yesterday’s post I talked about a report commissioned by The Lancet to look at liver disease in the UK.  It’s launch was picked up by the media with the BBC reporting on it.

Their coverage included these statements:

A group of doctors and researchers have criticised a reliance on “outdated” blood tests for diagnosis – saying these sometimes give false reassurance.  The report says picking up cases earlier leads to better outcomes for patients.

Prof Roger Williams, who led the research and is the director of the Institute of Hepatology in London, said: “The rising rates of mortality from liver disease over the past three decades are a terrible reflection on the UK.  Deaths will continue to rise until there are radical improvements in treatment services.”

“And early detection of liver disease by GPs and primary care services is virtually non-existent.  GPs know very little about it and don’t particularly want to get involved.  The ordinary test for liver function often shows as normal – even when someone has cirrhosis.”

The report says GPs rely on blood tests that show inflammation to the liver, which can fluctuate, rather than having access to scanners, which give a more consistent picture of scarring.

Another member of the team, Dr Nick Sheron, who runs the liver unit at Southampton General Hospital, said: “GPs don’t have access to the right technology.  They are using blood tests which simply don’t work. It’s 19th Century technology for a 21st Century problem.”

Prof Sir Ian Gilmore, who co-founded the Alcohol Health Alliance UK, said: “Getting people to reduce their drinking works and is really cost-effective.

“But our politicians will not take this seriously.

“Alcohol dependency is treated as a lifestyle choice – like a designer brand of jeans – rather than as a disease.”

You can read the full story here

11 thoughts on “Early detection of liver disease by GPs ‘non-existent’

  1. hmmm…. in detailed report the Chairman of the Royal College of GPs said:

    “Our influence is limited. It is politicians who need to act now and introduce measures to really make a difference.”

    so the GPs pass the ball back to the Government – who are relying on GPs to provide advice in the form of IBAs?

    in a report you linked to a few days ago there was reference to ‘upstream’ control measures as being the only ones likely to make a difference – ie minimum unit pricing. I’m pleased to see that the Welsh and Irish governments are considering MUP proposals but seriously – we in England need to get with the expletive deleted programme!!!!!!!!!!

    1. Oh Prim – I could go off in a million different directions to answer this one but I won’t 😉 Suffice it to say that some of my posts lined up for January both look at this and raise more ‘passing of the ball’ observations when it comes to alcohol abuse and dependence. As Nick Sheron says updating the technology used by GP’s to diagnose liver disease would be a big step forward. The cost savings to the NHS further down the line should off-set the cost of implementation I would suspect. Plus implementing alcohol interventions linked to QOF points for GP’s would be a very big carrot to getting them engaged! But yes ultimately it needs to come from the top of govt and public health bodies, these are supposed to look out for us and act in our best interests ……

  2. Now as a person who’s terrified of what they might have done to their liver and thinking of visiting my GP I’m really quite worried about this. If I have damaged myself how do I actually get the help I need. Its so scary.

    I’d listened to the radio today it said that Scotland still have a 20% higher issue with alcohol consumption than the rest of the UK (although no reference to where this came from) and we have increased pricing.

    It, booze, should be seen more like a time bomb than a pair of designer jeans……..

    Its such a worry, the stigma attached to getting help via GP’s is huge for lots of people i know, and to think its not effective either is bloody scary.

    Thanks for the links, very useful.

    1. Hey Daisy – yes I’ve picked up that news story you were listening to and there’s a post coming up about it 😉 As for the GP issue, it is really tricky as it depends on them being informed and interested in alcohol issues and not compromised by their own drinking concerns or denials. The number of people who are terrified of addressing the issue via their GP is huge as you say and we need to address this and fast. If you are worried you need to be honest with your GP about your prior drinking (and share with pride how long it is since you last had a drink!) and ask for an LFT (liver function test) blood test. They would only refer for further tests if your LFT’s were raised and abnormal but if you’ve stopped for almost 70 days (woohoo!) then any inflammation should have been resolved and my guess would be that they would be normal (mine were and I went exactly 2 months after quitting). I’m not sure if you can access a liver scan privately but suspect so and this could be a lucrative business for which every private hospital group started to offer it as I would pay good money to check my liver health with a scan without going via my GP! PS I got round sharing my concerns with my GP as I was called for my over 40’s NHS health check and as I take blood as part of my job knew to ask the phlebotomist just to add a tick to LFT’s on the form and it was job done! (it is part of a regular U&E [urea and electrolytes] blood test which is taken as part of this check) No one followed up why I had asked for this which is interesting and revealing in itself.

  3. “Treated as a lifestyle choice” so sad, but so true 🙁 In your response to Daisy, you said the inflammation can resolve itself if one has stopped drinking? I have blood tests regularly, because I take a statin drug for cholesterol, and one of the tests is for liver enzymes, I guess these results would show if there were any issues due to drinking? Mine have been normal, thankfully, except for once last year, when my drinking had really gotten out of control, but the results have been normal since then(and since I’ve stopped drinking). Are there any really obvious symptoms of liver disease, except for jaundice, that would prompt a GP to order more tests? I just wonder if people don’t worry about liver issues, because it’s “out of sight, out of mind?” Sorry for my rambling—just have lots of questions I suppose 😉 xx

    1. Hey Lori 😉 If you’re having regular blood tests that cover liver enzymes then yes any issues should show up (depending on what liver enzymes they are looking at). I’m thinking of doing a post detailing more about liver blood tests so that readers can have a better understanding of what they all mean – do you think that would be helpful? As to obvious signs of liver disease – not really, unless you present with pain over your liver. The liver has no nerve fibres so we don’t normally know there is a problem until 75% of the damage is done and then the symptoms are as you say, jaundice and other more acute presentations. Here are a full list of the symptoms of alcoholic liver disease: http://www.nlm.nih.gov/medlineplus/ency/article/000281.htm. By all means email me if you have any specific questions 🙂 xx

      1. Thanks for the info and the link :). Yes, I think a post about liver blood tests would be helpful. It is encouraging to know the liver can heal if cirrhosis isn’t present yet. Thanks Lou! xx

      2. You’re welcome Lori! There is a stage before cirrhosis called fatty liver and the liver can recover from this if we stop drinking, switch to a low fat diet and exercise. I’ll do the post about liver blood tests in the New Year 🙂 xx

  4. Hi Lucy! It’s Amy, the one who works in public health in Indiana, US. Still loving your blog! Thanks so much for keeping up with it after your year anniversary. Congrats, btw! I’ll have 5 months on Dec. 14th. 🙂 I’m hoping you can make a suggestion for me. I’ve been trying to get a link to or a copy of A Royal Hangover to no avail. Would love to have a viewing party at my place for my sober friends and I. I emailed the address listed on their website, but did not hear back. Do you have any suggestions? It’s not playing here in the US. Thanks!!!

    1. Hey Amy! Congrats on 5 months – awesome 🙂 I happen to be in touch with the producer of the film and will email your message to her and see if she can help you out. Thanks for the congrats too 😉 Edited to add: here’s the reply from Gabrielle Weller, the film’s producer: The film is still on the international film festival circuit and as such isn’t being released outside of independent movie theatres (in the UK, Australia and the US) until April next year when it will be available on NetFlix and also shown on television across the UK, US and Australia. Follow the facebook page of ‘A Royal Hangover’ for all updates on distribution and screenings. 🙂

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