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Liver disease ‘picked up quicker’ by nurse-led tests in GP surgeries

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Simple tests by nurses in GP surgeries could potentially double the diagnosis rate of liver disease where patients are not displaying any symptoms, according to UK researchers.

Mortality rates from chronic liver disease have risen sharply in the UK and it is now the third most common cause of early death, they said.

“The incorporation of a liver health nurse into GP practices was simple to arrange”

Magdy El-Gohary

The researchers, from the University of Southampton, also highlighted that the disease progressed silently, with few symptoms appearing before serious cirrhosis developed.

The increase was predominantly due to alcohol, they said, but the increasing prevalence of non-alcohol related fatty liver disease both in the UK and elsewhere was also of concern.

Writing in the journal PLOS ONE, they noted the limitations of primary care in the area at present but highlighted the potential that GP practices had to find more cases earlier.

“Primary care presents an opportunity to identify at risk populations, however assessment largely comprises of indirect markers of fibrosis which have little prognostic value,” they said.

They trialled whether setting up nurse-led liver clinics using additional non-invasive testing would increase the number of new diagnoses of liver disease compared to usual care.

They allocated 10 GP practices to either intervention – where patients were tested by specialist liver nurse – or care as usual.

Patients had a full liver assessment which involved a simple examination – taking blood samples and measuring liver stiffness using a portable FibroScan 402 ultrasound device.

All participants had their case notes reviewed by a consultant hepatologist and recorded as either “no fibrosis”, “liver warning”, “progressive fibrosis” or “probable cirrhosis”.

Of the 910 participants seen in the nurse-led clinic, nearly half were found to have some form of liver disease, said the researchers.

Of these, 44 had probable cirrhosis, 141 had progressive fibrosis and 220 had liver warnings. Overall, the nurse-led clinic diagnosed twice as many cases as the care as usual clinics.

Lead Author Dr Magdy El-Gohary said: “Incorporating a liver nurse within primary care was simple to arrange and yielded a much higher number of new diagnoses of liver disease compared to usual care.

“The next step is to roll this service on a larger scale so that we can show whether early diagnosis is able to prevent the liver disease developing to the stage where an emergency admission to hospital is required,” he said.

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