Tackling surging alcoholic liver disease
Centre investigator Professor Nick Sheron and his team have delivered the research evidence, new clinical tools and advocacy needed to define and tackle the UK's surging rates of alcohol-related liver disease.
- Identified a 400% increase in alcohol-related liver disease cases since 1970
- Established that 75% of liver disease cases not picked up at an early, more treatable stage
- Developed a traffic-light liver health test for early diagnosis and management
- Consistently provided evidence for a combination strategy in alcohol policy
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A vital organ at the centre of a silent epidemic
Excessive alcohol consumption injures the liver, which is critical to our metabolism of nutrients and normal function. The liver can recover from intermittent alcohol-induced inflammation, however sustained overconsumption causes progressive fibrotic scarring and loss of function, termed cirrhosis.
In 2013, analyses of public health data by Prof Sheron and colleagues raised the alarm on a 400% increase in liver disease mortality since 1970, with alcohol consumption the key factor in 75% of all hospital cases of end-stage cirrhosis.
Defining the clinical problem: Caught too late
Acting on liver disease and excess alcohol consumption at an early stage halts progression of the disease in the majority of cases, however Prof Sheron's team demonstrated that early intervention was rare.
They found that three quarters of hospital cases with a first diagnosis have liver disease which was not picked up in primary care. This was largely due to insensitive and misleading tests more likely to generate unnecessary referrals of healthy individuals than identify those at risk.
Shifting the clinical focus
Those findings helped re-focus attention on developing clinical service in primary care to detect and treat early-stage liver disease, reducing costly hospitalisations, unnecessary treatments and services.
To address this Prof Sheron's team developed a cheap accurate primary liver diagnosis using a simple amber / red traffic light system based on routinely-collected biochemistry easily incorporated in primary care. This test aims to detect early stage alcohol-related cirrhosis, long before existing assessments could identify a patient with poor liver health.
They have shown that providing people with a simple, clear sense of their own liver health using the traffic light system, alongside qualitative changes to engagement (e.g. describing liver scarring in place of only advising on aelf-management) through nurse-led community clinics has the potential to stop harmful drinking in 65% of cases.
Pull-through and policy impacts
Those approaches to detecting and managing alcohol-related liver diseases, developed through our NIHR BRC liver research activities, are now undergoing regional level implementation and assessment through the NIHR's Wessex Collaboration for Leadership and Applied Health Care Research (CLAHRC).
The team's work also informed the 2014 Lancet Commission: Addressing the Crisis of Liver Disease in the UK, which placed early detection and community screening top of its priorities, and also provided the basis for Prof Sheron's secondment to Public Health England to work on a new national liver care framework.
Prof Sheron has long been clear that effective intervention requires a combinatorial approach and the work through our Centre has fed into advocacy for integrating refocussed clinical management with public health policy measures tackling the key population level drivers for liver disease; cheap alcohol and the obesiogenic environment.
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