January 2017 is Love Your Liver month in the UK. The awareness campaign, organised by the British Liver Trust, the leading charity supporting adults with liver conditions, aims to publicise the best way to look after your liver by avoiding the three main contributors to liver damage: alcohol, fat and viral hepatitis.
This campaign comes shortly after the recommendation in December 2016 that heavy drinkers should be sent for regular liver scans. The National Institute for Health and Care Excellence (NICE) released new draft guidelines advising that GPs should refer ‘harmful’ drinkers for liver scans, even if they do not present symptoms of liver damage. A harmful drinker is defined as a woman who regularly drinks more than 35 units of alcohol (three and a half bottles of wine), or a man who drinks 50 units (five bottles of wine) per week.
The advice will remain in the consultation stage until February 2017 but, if adopted, it aims to increase diagnoses of liver damage at the early stages when disease is still treatable. Adults who are diagnosed with liver damage early enough can make lifestyle changes or undergo treatment that allows the liver to recover. Waiting until symptoms appear to scan the liver can result in this stage being missed, as there may be no warning signs of cirrhosis until the damage is so extensive that the liver can no longer function. Treatment at this stage is far more invasive or, in some cases, impossible.
The NICE recommendations may be of particular interest to women, after the news in October 2016 that they are for the first time now drinking almost as much as men. A study published by the British Medical Journal (BMJ) found that men born towards the end of the 20th century are only slightly more likely to drink to problematic levels than women of the same age. Men born at the beginning of the century, meanwhile, were three times as likely as women to drink to problematic levels. The chances of developing health problems such as liver damage from drinking are almost the same for men and women today, though in previous generations it was far more common in men.
The campaign also advises that heavy drinking is a key factor in the development of liver problems. The British Liver Trust recommends drinking no more than 14 units per week, taking three days off from alcohol per week and avoiding drinking completely if pregnant or trying to conceive. However, the campaign also focuses on two other leading causes of liver problems: fatty liver and viral hepatitis (hepatitis can be contracted from contaminated blood and diagnosed with a blood test).
Love Your Liver emphasises that patients with poor diets or those who are overweight may be at risk of non-alcoholic fatty liver disease, yet they will not necessarily benefit from the recent NICE recommendations. The consultation notes the risk that non-alcoholic fatty liver disease poses in terms of leading to cirrhosis, and recommends that patients recently diagnosed with the disease should be advised on making healthy lifestyle changes. However, NICE does not recommend that those with very poor diets be regularly screened in the same way as heavy drinkers. The British Liver Trust advises that, to improve liver health, a healthier diet and regular exercise is essential.
Elise Bevan, a solicitor in the clinical negligence team at Penningtons Manches LLP, said: “We welcome the proposed guidelines, which we anticipate will encourage GPs to screen patients before symptoms become too severe so that action can be taken before damage becomes irreversible. We hope the guidelines will inform patients and educate clinicians. GPs are now better equipped to offer the right direction to improve a patient’s care and outcomes than they were before. We do, however, fear a deluge of patients swamping surgeries when there is already a shortage of GP appointments, and there will be resultant costs to the health service, but we hope it will be negated by treating fewer patients with advanced liver disease.”