Should we screen for cirrhosis?

July 13, 2017, British Medical Journal

Recent guidelines are right to recommend screening high risk patients for cirrhosis, say liver specialists Mark Hudson at Freeman Hospital, Newcastle upon Tyne, and Nick Sheron at Southampton General Hospital.

They say liver disease will probably overtake heart disease to become the commonest cause of death in working age people in the next year or so, mainly because it develops without signs or symptoms and options to tackle alcohol and obesity - the commonest causes of liver disease - are limited.

Yet technologies to identify early liver disease exist, they say, and are supported by the National Institute for Health and Care Excellence (NICE).

NICE recommends that men and women drinking alcohol at potentially harmful levels - more than 50 and 35 units a week, respectively - be offered a (transient elastography) to exclude . This equates to about 2.25 million people in England and Wales.

They point out that few GPs currently have access to this test, "so it is not going to happen overnight." However, because the lifetime cost of treating liver disease is between £50,000 and £120,000, "this approach is likely to be cost effective," they write.

"We will need properly controlled trials, and these studies are in preparation," they say. "However, the burden of liver disease is such that doctors cannot simply sit in their ivory towers waiting for patients with liver to come and find them."

But other experts argue that despite recent recommendations from NICE, "insufficient evidence supports a programme for cirrhosis."

Liver specialists Ian Rowe at the University of Leeds, and Gideon Hirschfield at Birmingham University's Liver Research Centre, say "for a successful screening programme the test used must be simple, cheap, and, most importantly, accurate."

Yet the test proposed to screen for cirrhosis has been shown to perform poorly in people suspected to have alcohol related , leading to many healthy people being incorrectly labelled as having cirrhosis and subject to further medical intervention, which comes with risk of physical and mental harm.

Also, the test "is not widely available and would require huge up-front investment to establish it in community settings," and "is probably not cost effective," they warn.

As such, they believe that implementation of screening for cirrhosis "would inevitably lead to disinvestment in other, more effective interventions, risking the overall health of the population."

Instead, they say resources should be targeted at managing risk factors for common diseases, such as alcohol consumption and obesity, as well as investing in well designed trials that evaluate the clinical and cost effectiveness of screening strategies.

Explore further: Family of patients with NAFLD and cirrhosis are at increased risk of liver fibrosis

More information: Mark Hudson et al. Should we screen for cirrhosis?, BMJ (2017). DOI: 10.1136/bmj.j3233

Related Stories

Family of patients with NAFLD and cirrhosis are at increased risk of liver fibrosis

June 19, 2017
Non-alcoholic fatty liver disease (NAFLD) is a common disorder characterized by abnormal accumulation of fat in the liver. NAFLD is diagnosed in up to one in three adults and one in 10 children in the United States, and obesity ...

Worldwide lack of early referral of patients with alcoholic liver disease

April 20, 2017
Results from a worldwide analysis of over 3,000 patients highlights that there is significant disparity in the referral of patients with liver disease, and that those with alcoholic liver disease (ALD) are 12 times more likely ...

Initial hospital contact for alcohol issues predicts cirrhosis

November 24, 2016
(HealthDay)—An initial hospital contact for alcohol problems is a significant predictor of alcoholic liver cirrhosis, particularly for patients 40 to 59 years and those diagnosed with harmful use or dependence, according ...

Drinking coffee may reduce the risk of liver cirrhosis

February 1, 2016
Regular consumption of coffee was linked with a reduced risk of liver cirrhosis in a review of relevant studies published before July 2015.

Risk of liver cancer low in patients with cirrhosis, study finds

February 1, 2017
The results of a study by researchers at The University of Nottingham suggest that the risk of liver cancer in patients with cirrhosis may be much lower than previously thought.

Severe gum disease strongly predicts higher mortality in cirrhosis

April 20, 2017
Results presented today from a prospective study in patients with irreversible scarring of the liver (cirrhosis) demonstrates that severe periodontitis (an inflammatory gum disease) strongly predicts higher mortality in this ...

Recommended for you

Effect of oral alfacalcidol on clinical outcomes in patients without secondary hyperparathyroidism

December 11, 2018
Treatment with active vitamin D did not decrease cardiovascular events in kidney patients undergoing hemodialysis, according to a research group in Japan. They have reported their research results in the December 11 issue ...

Study identifies a key cellular mechanism that triggers pneumonia in humans

December 11, 2018
The relationship between influenza and pneumonia has long been observed by health workers. Its genetic and cellular mechanisms have now been investigated in depth by scientists in a study involving volunteers and conducted ...

Human antibody discovery could save lives from fungal killer

December 11, 2018
A new way to diagnose, treat and protect against stealth fungal infections that claim more than 1.5 million lives per year worldwide has been moved a step closer, according to research published in Nature Communications.

Dialysis patients at risk of progressive brain injury

December 10, 2018
Kidney dialysis can cause short-term 'cerebral stunning' and may be associated with progressive brain injury in those who receive the treatment for many years. For many patients with kidney failure awaiting a kidney transplant ...

Silicosis is on the rise, but is there a therapeutic target?

December 6, 2018
Researchers from the CNRS, the University of Orléans, and the company Artimmune, in collaboration with Turkish clinicians from Atatürk University, have identified a key mechanism of lung inflammation induced by silica exposure, ...

PET scans to optimize tuberculosis meningitis treatments and personalize care, study finds

December 6, 2018
Although relatively rare in the United States, and accounting for fewer than 5 percent of tuberculosis cases worldwide, TB of the brain—or tuberculosis meningitis (TBM)—is often deadly, always hard to treat, and a particular ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.