New guidelines aim to improve the diagnosis of liver disease, developers say.
Backed by the British Society of Gastroenterology, the guidance aims to reduce unnecessary testing for liver disease – as well as ensuring early diagnosis when disease is present.
They are released as the disease becomes one of the few to have increasing mortality rates.
According to the guideline developers, mortality rates among those under the age of 65 have increased by six times in 40 years.
The guidelines, published in Gut, say that initial investigation should include bilirubin, albumin, ALT, alkaline phosphatase (ALP) and gamma-glutamyltransferase (GGT) plus a complete blood count.
Professor Philip Newsome, from the University of Birmingham’s Institute of Immunology and Immunotherapy, leader of the guidelines development work, said: “Since the current liver blood tests were developed in the 1950s, they have been the mainstay of liver disease identification. Unfortunately, the way liver blood tests are interpreted means that many patients with liver disease are not identified until at a late stage.
“Liver blood or function tests are checked ever more frequently in both primary and secondary care in an attempt to exclude liver disease, for the monitoring of potential adverse effects of drugs on the liver such as statins, and for the investigation of the generally unwell patient.
“These tests often produce an abnormal result, the clinical significance of which is unclear.
“In many cases they are requested in response to non-specific symptoms where there is little potential link between symptoms and likelihood of liver disease, or the blood tests are performed for unrelated reasons such as chronic disease monitoring.”
He added: “This frequently leads to a cycle of additional liver blood test testing in an otherwise asymptomatic individual. Notably, many patients referred to hospital with abnormal liver tests do not have any evidence of significant liver disease.”
Newsome et al. Guidelines on the management of abnormal liver blood tests Gut 1 January 2018; doi:10.1136/gutjnl-2017-314924 [abstract]
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