Care standards for non-alcoholic fatty liver disease in the United Kingdom 2016: a cross-sectional survey - PubMed (original) (raw)

doi: 10.1136/flgastro-2017-100806. Epub 2017 Apr 28.

Guru Aithal 2, William Alazawi 3, Michael Allison 4, Quentin Anstee 5, Jeremy Cobbold 6, Shahid Khan 7, Andrew Fowell 8, Stuart McPherson 9, Philip N Newsome 10 11, Jude Oben 12, Jeremy Tomlinson 13, Emmanouil Tsochatzis 14

Affiliations

Care standards for non-alcoholic fatty liver disease in the United Kingdom 2016: a cross-sectional survey

David A Sheridan et al. Frontline Gastroenterol. 2017 Oct.

Abstract

Objective: Guidelines for the assessment of non-alcoholic fatty liver disease (NAFLD) have been published in 2016 by National Institute for Health and Care Excellence and European Associations for the study of the Liver-European Association for the study of Diabetes-European Association for the study of Obesity. Prior to publication of these guidelines, we performed a cross-sectional survey of gastroenterologists and hepatologists regarding NAFLD diagnosis and management.

Design: An online survey was circulated to members of British Association for the Study of the Liver and British Society of Gastroenterology between February 2016 and May 2016.

Results: 175 gastroenterologists/hepatologists responded, 116 completing the survey, representing 84 UK centres. 22% had local NAFLD guidelines. 45% received >300 referrals per year from primary care for investigation of abnormal liver function tests (LFTs). Clinical assessment tended to be performed in secondary rather than primary care including body mass index (82% vs 26%) and non-invasive liver screen (86% vs 32%) and ultrasound (81% vs 37%). Widely used tools for non-invasive fibrosis risk stratification were aspartate transaminase (AST)/alanine transaminase (ALT) ratio (53%), Fibroscan (50%) and NAFLD fibrosis score (41%). 78% considered liver biopsy in selected cases. 50% recommended 10% weight loss target as first-line treatment. Delivery of lifestyle interventions was mostly handed back to primary care (56%). A minority have direct access to community weight management services (22%). Follow-up was favoured by F3/4 fibrosis (72.9%), and high-risk non-invasive fibrosis tests (51%). Discharge was favoured by simple steatosis at biopsy (30%), and low-risk non-invasive scores (25%).

Conclusions: The survey highlights areas for improvement of service provision for NAFLD assessment including improved recognition of non-alcoholic steatohepatitis in people with type 2 diabetes, streamlining abnormal LFT referral pathways, defining non-invasive liver fibrosis assessment tools, use of liver biopsy, managing metabolic syndrome features and improved access to lifestyle interventions.

Keywords: FATTY LIVER; LIVER BIOPSY; LIVER FUNCTION TEST; NONALCOHOLIC STEATOHEPATITIS.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1

Figure 1

UK non-alcoholic fatty liver disease survey data estimated number of referrals to gastroenterology and hepatology with abnormal liver function tests (number of respondents).

Figure 2

Figure 2

Modalities performed to assess for liver fibrosis (% of respondents). ELF, Enhanced Liver Fibrosis; NAFLD, non-alcoholic fatty liver disease.

Figure 3

Figure 3

Factors influencing use of liver biopsy in non-alcoholic fatty liver disease (NAFLD) assessment. ELF, Enhanced Liver Fibrosis; NASH, non-alcoholic steatohepatitis.

Figure 4

Figure 4

(A, top panel) Factors favouring follow-up in secondary care. (B, bottom panel) Factors favouring discharge from secondary care. NAFLD, non-alcoholic fatty liver disease; NASH, non-alcoholic steatohepatitis.

References

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