Head To Head

Should we screen for cirrhosis?

BMJ 2017; 358 doi: https://doi.org/10.1136/bmj.j3233 (Published 12 July 2017) Cite this as: BMJ 2017;358:j3233
  1. Mark Hudson, consultant hepatologist1,
  2. Nick Sheron, head of clinical hepatology2,
  3. Ian A Rowe, university academic fellow3,
  4. Gideon M Hirschfield, professor4
  1. 1Freeman Hospital, Newcastle upon Tyne, UK
  2. 2Southampton General Hospital, University of Southampton, UK
  3. 3Leeds Institute for Data Analytics, University of Leeds, UK
  4. 4Centre for Liver Research, NIHR Biomedical Research Centre, University of Birmingham, Birmingham, UK
  1. Correspondence to: M Hudson Mark.Hudson{at}nuth.nhs.uk, I A Rowe i.a.c.rowe{at}leeds.ac.uk

Recent guidelines are right to recommend screening high risk patients for liver cirrhosis, say Mark Hudson and Nick Sheron. But Ian Rowe and Gideon Hirschfield worry about the lack of a suitable screening test

Yes— Mark Hudson and Nick Sheron

Liver disease is the second leading cause of potential years of working life lost in England and Wales (72 684), after ischaemic heart disease (77 432). But although years lost from ischaemic heart disease have fallen by a factor of four since 1979, those from liver disease years have increased threefold and are still increasing.1 The increase is in constrast to the trend in Mediterranean regions of Europe (France, Italy, Spain, Portugal, and Greece), which historically had the highest cirrhosis mortality but have seen significant declines. Reduction in alcohol consumption, hepatitis B vaccination and reduced hepatitis C transmission have contributed to this decrease.2

Liver disease will probably overtake heart disease to become the commonest cause of death in working age people in England and Wales in the next year or so. Only a third of patients admitted to hospital with liver disease will recover. There is no indication that things are improving, and there are at least two reasons for this.

Firstly, therapeutic options for the commonest causes of liver disease, alcohol and obesity, are limited. Secondly, liver disease develops without signs or symptoms, and many patients present with often fatal complications of late stage cirrhosis. Data presented in the Lancet commission report in 2014 indicated that 75% of 5000 patients admitted as an emergency for liver disease in Southampton had not been previously referred to a liver or gastroenterology clinic, suggesting that the liver disease had not been detected beforehand.3

Detection in primary care

Liver disease takes between 10 and 50 years to progress through fibrosis to cirrhosis, portal hypertension, liver failure, and liver cancer. It ought …

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