Benefits of FibroScan® to patients
Scanning for liver disease
Professor Graham Foster FRCP and Dr Phillip Harrison FRCP
Over the last few years, we have seen enormous strides in the diagnosis and
management of common conditions and, for many medical disorders, mortality
is now falling. Many advances have been led by primary care physicians
focusing on early diagnosis and appropriate intervention. Sadly, liver disease
has not followed this profile, and mortality in people younger than 65 continues
to rise at an alarming rate.
The increase in liver mortality is a consequence of the three big liver killers
– alcohol, fatty liver disease and viral hepatitis. One of the problems of early
intervention in liver disorders, is the lack of easy to use screening tests; our
current panoply of blood tests and ultrasound scans is not good enough to
identify patients who require further intervention. Every doctor is familiar with
the ‘moderate drinker’ who has minor abnormalities in their liver function tests
and turns out to have cirrhosis on their liver biopsy. Equally, we have all seen
many young people with quite deranged liver function tests, who have trivial
disease on further investigation. We cannot offer a liver biopsy to every patient
at risk of liver disease, and therefore have been unable to introduce effective,
targeted interventions in primary care.
All this is about to change.
FibroScan® provides an accurate assessment of
the degree of liver fibrosis and allows doctors to stratify patients into those
who require further investigation, and those for whom simple lifestyle advice
on alcohol and weight loss will suffice. FibroScan® has previously only been
available in specialist liver centres, however, London Bridge Hospital is now
able to offer FibroScan® diagnosis and reporting to primary care physicians.
The service allows doctors to identify patients at risk of occult liver disease (i.e.
people with a history of excess alcohol use or obesity), who require specialist
referral, and has the potential to significantly improve the management of
patients at risk of liver disease.
1. Williams, R, et al, Addressing Liver Disease in the UK. The Lancet 2014; 384: 1953-1997.
Illustrative case history
A 63-year-old man was referred
to a specialist dietitian for advice
on weight loss. He had a BMI
of 31 and admitted to drinking
2-3 bottles of wine per week.
Examination was unremarkable,
but his ALT was slightly raised
at 45 IU/ml. A FibroScan® was
performed and showed a reading
of 22 – indicative of cirrhosis. The
patient subsequently admitted
that his alcohol consumption might
have been greater than previously
indicated. A screening endoscopy
showed small varices and the
patient is now under specialist
care with support for his alcohol
addiction, dietary interventions to
reduce weight, as well as therapy
for his portal hypertension and
regular screening for liver cancer.
This patient illustrates the difficulty
in establishing a diagnosis of
significant liver disease using
conventional means, and the value
of FibroScan® in identifying patients
with fibrosis requiring intervention.
For more information, please contact the
GP Liaison Department
T: 020 7234 2009