Liver disease is silent. It progresses slowly over time and produces few symptoms until the advanced stages of the disease. Alarmingly, deaths from liver disease in England have increased by 25% over the last 10 years and cirrhosis is now the fourth most common cause of life years lost in the UK under the age of 75 years, after heart disease, breast and lung cancer.
Why is liver disease prevalent in the UK?
Few people appreciate that the recent rise in liver disease has very little to do with changes in alcohol consumption and a lot more to do with increasing levels of obesity and diabetes. Fatty liver affects up to a third of adults in the western world and increases the risk of liver fibrosis and cirrhosis. When you add to that the effects of regular (but not necessarily excessive) alcohol consumption the risk of liver disease can increase by more than five-fold.
An added concern in the UK is the recent publication of data by the Lancet Commission and the government’s own NCEPOD review, which showed that levels of quality of care and survival for individuals with liver disease vary alarmingly in the NHS. Premature deaths from liver disease can vary by up to a factor of 7 from one health region to another.
How is liver disease diagnosed?
The good news is that it is easier to get checked out for liver disease than ever before due to advances in diagnostics, and we should remember that most liver diseases are treatable and, in many cases, curable. The key is to identify problems early and get expert advice.
The NICE review of fatty liver and alcohol liver disease recommended that all at-risk patients should be checked for the risk of liver scarring, but sadly very few patients get referred to these tests. Moreover, not all hospitals have a liver specialist and so it is always worth looking for someone who has expertise in this area (i.e. a hepatologist), as they are likely to have access to the tests that can identify the early signs of liver damage. These days it is possible to spot early signs of harm with scans or a special blood test that detects fibrosis.
It is very easy to arrange a quick review and have a liver MOT. Ask whether your specialist regularly uses blood tests such as the extended liver fibrosis screen (ELF test) or non-invasive machines such as FibroScan which can demonstrate whether you have a problem to fix before it’s too late.