The revised ‘abnormal liver function test’ pathway is now live on the Camden GPwebsite, available here.
These changes were encouraged by the excellent outcomes of the NAFLD pathway* and by national guidelines which now recommend use of non-invasive tests for liver fibrosis in patients with alcohol use disorders.1,2
The main changes to the pathway are:
- GPs should now be doing an ELF test in patients with fatty liver and abnormal LFTs who drink >/14 units alcohol per week (without first doing a FIB 4 score like in NAFLD).
- GPs should also be doing an ELF test on patients with hazardous or harmful alcohol use who have normal LFTs (25% of patients with cirrhosis have normal LFTs). This will be updated in the alcohol pathway in the coming months.
- Referral threshold for ELF score has now changed from 9.5 to 9.8 for NAFLD, in line with up to date evidence. (Refer to hepatology clinic if ELF = >/9.8, indicating advanced liver fibrosis). This threshold of 9.8 will be the same for alcohol.
- Maximum safe alcohol units per week updated to 14 units for men and women, as per national guidance.
* The NAFLD pathway led by Camden CCG resulted in a 5-fold increase in the detection of advanced liver fibrosis, 81% reduction in unnecessary referrals to hepatology clinic and significant cost saving.
1) P Newsome RC, S Davison et al Guidelines on the management of abnormal liver blood tests [webpage]. https://www.bsg.org.uk/resource/guidelines-on-the-management-of-abnormal-liver-blood-tests.html: Gut Online; 2017 [updated 2017; cited 2017 2017].
For more information, contact Dr Freya Rhodes RFL at firstname.lastname@example.org or Dr Sarah Morgan GP at email@example.com.