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Benefits of FibroScan® to patients

page

thirteen

Case Study

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.

1

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.

Reference

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

on:

T: 020 7234 2009