Revised ‘abnormal liver function test’ pathway now available

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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:

  1. 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).
  2. 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.
  3. 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.
  4. 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].

2)     https://www.nice.org.uk/guidance/ng50

For more information, contact Dr Freya Rhodes RFL at freya.rhodes@nhs.net or Dr Sarah Morgan GP at sarah.morgan1@nhs.net.

Expiry date: Nov 29th, 2019