Research shows liver disease could be picked up much sooner by nurses in GP Surgeries

Research carried out by scientists at the University of Southampton has shown that simple tests in GP surgeries could potentially double the diagnosis rate of liver disease where patients are not displaying any symptoms.

Chronic liver disease is an escalating problem both in the United Kingdom and worldwide. In the UK mortality rates have risen sharply and it is now the third most common cause of early death. The disease progresses silently, with few symptoms appearing before serious liver scarring (known as cirrhosis) develops. The increase is predominantly due to alcohol, however the increasing prevalence of non-alcohol related fatty liver disease both in the UK and elsewhere is also of concern.

The objective of this research, published today in PLOS ONE was to identify previously undiagnosed liver disease within Primary Care using a nurse-led specialist liver clinic. Ten GP practices were randomised to either intervention (where patients were tested by specialist liver nurse) or care as usual. Participants recruited to the intervention practices had a full liver assessment which involved a simple examination; taking blood samples and measuring liver stiffness using a portable FibroScan®402 ultrasound device, a machine that offers a non-invasive liver assessment. All participants had their case notes reviewed by a consultant hepatologist and ascribed as ‘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. 44 of these patients (4.8%) had probable cirrhosis, 141 (15.5%) had progressive fibrosis, and 220 (24.2%) 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 from the School of Medicine at the University of Southampton said:

“Catching liver disease in primary care before it's too late should be possible. 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.”

The aim of this programme of work is to reduce the number of avoidable premature deaths from undiagnosed liver disease. Offering a specialist liver clinic within Primary Care means that patients can be assessed and diagnosed quickly and may reduce or halt the progression of liver disease.