Resources for those working in primary care

Liver disease is the third most common cause of premature death in the UK.  It is often diagnosed too late, when intervention is less effective.

Primary care can play a key role in the early detection of those who are at risk or in the early stages of liver disease. The goal is for GPs to intervene before advanced liver disease becomes established but also to manage the early stages of disease – for example by offering alcohol reduction or weight management interventions.

The two most common types of liver disease that will be seen in primary care are alcohol-related liver disease and non-alcohol related liver disease (NAFLD).

NICE recommends that all persistently heavy drinkers have a liver fibrosis assessment, independent of derangements in LFTs. This translates as all ‘men who drink >50 units of alcohol per week and women who drink >35 units of alcohol per week and have done so for several months’ being offered transient elastography (fibroscan).

NAFLD is common and about 10% of those with NAFLD (2–3% of the total population) will have non-alcoholic steatohepatitis (NASH) with risk of progressive fibrosis leading to cirrhosis. It is recommended that you consider those who are overweight, have type 2 diabetes or metabolic syndrome.