People drinking at potentially harmful levels should be sent for scans to detect early liver disease, according to new draft guidance from the National Institute for Health and Care Excellence (NICE). The proposed quality standard, which is out for consultation until early February, recommends that men drinking more than 50 units per week and women drinking more than 35 units – adding up to around 1.9m people in England – should be sent for cirrhosis scans by their GPs.
The document recommends two non-invasive tests – transient elastography and acoustic radiation force impulse imaging – to detect early signs of liver problems. While the first test is available in around 120 hospitals, the second is more recent technology and so far not as widespread. Ten years ago clinicians would usually have had to perform a liver biopsy to make a diagnosis.
More than 4,000 people a year die from liver disease in England and Wales, making it the fifth largest cause of death, while 700 more patients need transplants. NICE would welcome comments from ‘anyone who has been affected by liver disease’ for the consultation.
‘Many people with liver disease do not show symptoms until it is too late,’ said deputy chief executive of NICE, Professor Gillian Leng. ‘If it is tackled at an early stage, simple lifestyle changes or treatments can be enough for the liver to recover. Early diagnosis is vital, as is action to both prevent and halt the damage that drinking too much alcohol can do. This draft quality standard makes a number of important suggestions to improve care for those with liver disease, from offering advice to less invasive testing.’
While the draft guidance has been welcomed by alcohol health organisations, free-market think tank the Institute of Economic Affairs (IEA) stated that the ‘average liver cirrhosis patient drinks vastly more than 35 units a week’ and that resources should be targeted on ‘chronic’ drinkers. ‘Unnecessarily testing millions of people on the basis of an arbitrary target would be a colossal waste of NHS resources,’ said its head of lifestyle economics, Christopher Snowdon.
Liver disease NICE quality standard: draft for consultation available at www.nice.org.uk until 2 February 2017