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Experts provide recommendations for combating liver disease in UK

Liver disease is the third most common cause of premature death in the United Kingdom, with mortality rates increasing by 400% since 1970. In a new report, Roger Williams, MD, director of the Institute of Hepatology in London, and colleagues provide recommendations for improving the standard of care for patients with liver disease in hospitals and create quality preventive measures for people with excessive alcohol use and obesity to reduce the mortality rate and burden of the disease.

“There is a human, social and financial imperative to act now if the UK’s burden of liver disease and all its consequences are to be tackled and the NHS is not to be overwhelmed by the cost of treating advanced stage liver disease,” Williams said in a press release. “The evidence outlined in the report, contributed by some of the UK’s leading experts in the field, should leave nobody in any doubt about the present unacceptable levels of premature death and the overall poor standards of care being afforded to liver patients.”

Roger Williams

Key recommendations:

Improving the level of expertise and facilities in primary care settings

Important elements of this recommendation to strengthen early detection of liver disease and its treatments include: classifying liver disease as one of the “so-called Big Five” major diseases to use chronic disease management and generic lifestyle interventions to their highest level, checking aspartate aminotransferase/alanine aminotransferase ratios in liver function tests to avoid unnecessary referrals for hospitalization and using liver elastography as the No. 1 test in the detection of hepatic fibrosis.

Improve support services in high-risk patient communities

Patients should be able to access more options for care, such as screenings, through local services. The experts recommend more hepatologists and experts work in collaboration with district general hospitals and primary care offices for ensuring they have the proper and required services for liver patients.

Ensure all district general hospitals and regional specialist centers have liver units

This recommendation is based on an enhanced 7-day acute service currently in the liver units in district hospitals, according to the report. The liver units in the hospitals would be linked to regional specialist centers, ensuring acutely sick patients would get the proper and highly specialized treatment they needed. Additionally, a multidisciplinary alcohol team, available 7 days a week, should be mandatory in every hospital, as well as care bundles established for the management of cirrhosis for primary hepatocellular carcinoma.

National review of liver transplantation

Organ donations are expected to increase by 50% by 2020, according to the report, so the recommendation is that the transplantation centers would be reviewed to conclude whether there is available space and financing for the increasing number of donor organs.

Strengthen transitional care from child to adult services

Pediatric and adult specialists are being recommended to work together with members of psychological, social and educational services to ensure transition from childhood to adulthood is handled appropriately.

Increase national action to reduce overall consumption of alcohol

The experts recommend a minimum price of 50 pence per unit of alcohol be enforced, implementing a tax on all alcohol products, every alcohol label listing health warnings, restricting the sale of alcohol to a specific time of day, and advertising and sponsoring of alcohol should be limited.  

Promote healthy lifestyles

This recommendation focuses on implanting government regulation of sugar content in food and drinks to reduce obesity, establishing metabolic clinics in hospitals to manage the effects of severe obesity and bariatric surgery and the Public Health England and Department of Education working collaboratively to promote healthy eating in schools.

Use antiviral treatments to reduce the hepatitis C virus infection by 2030

Using new antiviral therapies and implementing screening programs among high-risk populations should be enforced to find unidentified patients with HCV and HBV. The universal six-in-one infant vaccination program against HBV would be cost effective like it has been in other nations, according to the report, and should be enforced. Infected mothers and children birthed to them should be monitored as well.

Increase medical and nursing training in the hepatology field

Creating new educational forums and training sessions for professionals in the field of hepatology would increase the number of doctors and nurses in hospitals and primary care settings.

Raise awareness of liver disease

The report recommends launching a national campaign to educate the public on liver disease and its consequences. The report also states the NHS and Public Health England should develop a plan for liver services to aid in the commissioning of local services.  

“The good news is that if our recommendations — many of which will require additional government regulatory action — are followed, deaths from liver disease will fall, with profound benefits in health and social well-being and economic productivity, as well as reduced costs for the NHS,” Williams said. “However, the health and policy reforms we are recommending need to take place now [because] the scale of the problem is too great for it to take second place to short-term political considerations.”

Disclosure: The researchers report no relevant financial disclosures.