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Refer 'harmful' drinkers for liver scans, says new NICE standard


Patients judged to be drinking too much, based on units consumed per week, should be sent for scans to detect early liver disease, according to the National Institute for Health and Care Excellence.

NICE has today published a draft quality standard to improve treatment and diagnosis of liver disease.

“Many people with liver disease do not show symptoms until it is too late”

Gillian Leng

It states that men drinking more than 50 units per week, or 22 pints, and women drinking more than 35 units per week, or 3.5 bottles of wine, should be sent for scans for cirrhosis by their GP practice.

It said that currently an estimated 1.9 million people in England fell into this category, based on figures from Public Health England.

Diagnosing cirrhosis would “ensure” patients received the treatment and support needed to manage their condition, according to NICE.

Offering patients’ non-invasive scans would avoid the need for a liver biopsy, it noted.

NICE backed two such methods – transient elastography, for all patients with risk factors for cirrhosis, and acoustic radiation force impulse imaging, for adults and young people with non-alcoholic fatty liver disease and advanced liver fibrosis.

However, NICE highlighted that access to the two tests recommended in its standard currently varied across England.

While transient elastography was on offer in at least 120 UK hospitals, it noted that the second test was a newer technology that was not as widespread.

The draft quality standard also called for those diagnosed with non-alcoholic fatty liver disease to be regularly tested for advanced liver fibrosis – to try and prevent it developing into cirrhosis.

Practice nurses and GPs should give healthy lifestyle advice to adults, young people and children who are newly diagnosed with non-alcoholic fatty liver disease, added the standard.

In addition, NICE called for all adults and young people with cirrhosis to go for ultrasound scans every six months for hepatocellular carcinoma, in a bid to improve earlier diagnosis.

The draft standard also backed improved treatment to prevent vein bleeds in some adults and young people with cirrhosis, with 2,687 people potentially eligible for treatment each year.


Gillian Leng

Liver disease is the fifth largest cause of death in England and Wales, it highlighted, with an estimated over 4,000 people dying from cirrhosis every year.

Professor Gillian Leng, deputy chief executive of NICE, said: “Many people with liver disease do not show symptoms until it is too late.

“If it is tackled at an early stage, simple lifestyle changes or treatments can be enough for the liver to recover,” she said. “Early diagnosis is vital, as is action to both prevent and halt the damage that drinking too much alcohol can do.

“This draft quality standard makes a number of important suggestions to improve care for those with liver disease from offering advice to less invasive testing,” she noted.

A consultation on the draft quality standard for liver disease is open until 2 February 2017.

The draft NICE quality standard on liver disease consists of the following statements:

  • Statement 1 – Adults, young people and children newly diagnosed with non-alcoholic fatty liver disease are given healthy lifestyle advice.
  • Statement 2 – Adults, young people and children with non-alcoholic fatty liver disease are offered regular testing for advanced liver fibrosis.
  • Statement 3 – Adults and young people with risk factors for cirrhosis are offered non-invasive testing for cirrhosis.
  • Statement 4 – Adults and young people with cirrhosis who do not have hepatitis B are offered 6-monthly ultrasound surveillance for hepatocellular carcinoma.
  • Statement 5 – Adults and young people with cirrhosis who have medium to large oesophageal varices are offered endoscopic variceal band ligation for the primary prevention of bleeding.

Readers' comments (2)

  • That's nice, but first you have to get a patient to admit truthfully how much they drink.

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  • "get a patient to admit truthfully"?For a start off, many people are in denial-not just alcohol misusers but also the obese person who only has one meal a day, the person with diabetes who says he has no sexual problems,infections and who is too busy to attend clinics or comply with his regime,the parents who give their child sweets because he kicks off otherwise-"he will loose his teeth anyway" so wheres the problem?
    As regards substance misuse, try and engage more with your patients in a non-judgemental way, and get as much information as you can-local treatment centres can supply more user-friendly information.
    The patients LF results will indicate the scope of any problems,but patients need a holistic approach.

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