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Liver Disease Insights

UK Population Oblivious That Cases Of Liver Disease - The ‘Silent Killer’ - Are Increasing

Survey reveals the vast majority of people are unaware of the prevalence of the disease 

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Liver disease is currently the fifth biggest killer in England and Wales, after heart disease, cancer, stroke and respiratory disease. Yet surprisingly, out of the five, liver disease is the only major cause of death still increasing year-on-year; with one-in-five people now at risk . Yet, 94% of respondents to a recent survey by Siemens Healthineers admitted to being unaware that cases of liver disease were increasing.

Often billed as the ‘silent killer’, liver disease has become dangerously ignored in recent years. In fact, only 2% of respondents said liver disease was the medical condition they were most concerned about. Cancer is the greatest worry for six in ten (60%) UK adults, followed by stroke (17%), heart disease (13%) and diabetes (8%). All of which are decreasing in their prevalence.

Despite a number of education programmes, almost one in ten (9%) admitted to being unaware that high alcohol consumption was a key contributor to liver disease. In addition, around half of people were unaware that a poor diet, obesity and undiagnosed hepatitis infection could also lead to the disease.

“Generally, people are much more worried about suffering from cancer, a stroke, heart disease or diabetes than they are from having liver disease,” says Peter Harrison, Managing Director, Siemens Healthineers GB and Ireland.

“Whilst these diseases are all concerning, Liver disease is the only major cause of death still increasing year-on-year . The lack of awareness of liver disease causes and symptoms means that people may be unaware they have the disease until it is too late. But it needn’t be that way.

“Advancements in early diagnosis means that a trip to the GP for a simple and quick blood test, or a referral for an ultrasound can help to reduce the number of people with advanced liver disease. However, an even better approach would be screening to turn the tide against a growing problem that’s often unnoticed until it’s too late. “

A liver biopsy is currently recognised as the ‘gold standard’ for diagnosing and assessing liver damage, however it’s increasingly being viewed as an expensive, uncomfortable and potentially risky procedure. The need for a faster, safer and more effective method of diagnosis is more important than ever.

Siemens Healthineers’ offers a number of non-invasive tests which help diagnose liver disease early. The simple blood test known as ELF is now included in NICE guidelines, and can be carried out quickly and easily, following a visit to a GP.

"The discovery of the ELF markers represents a significant advancement in the diagnosis of patients with liver disease. Of particular benefit, the ELF test can help diagnose patients with mild-to-moderate liver fibrosis, which is usually asymptomatic, so that clinicians are able to intervene before significant damage to the liver occurs," adds Prof William Rosenberg, DPhil, UCL Institute for Liver and Digestive Health at University College London.

Siemens Healthineers’ ultrasound technique, Virtual Touch Quantification™ (VTQ), can also help with early detection by assessing the stiffness of the liver based on readings from invisible, high-intensity waves transmitted through the liver.

Should you be worried that you may be suffering from liver disease, it is recommended you contact your local GP.

The survey of 2,000 UK adults aged 18 and over was undertaken on behalf of Siemens Healthineers by Arlington Research during January 2017.

Siemens Healthineers portfolio of liver tests

Statistics from the British Liver Trust show that deaths from liver disease have increased 400% in the past 40 years with costs that could rise above £1bn a year unless action is taken.

Survival rates have improved for almost every disease of every organ in the last few decades, with one notable exception: liver disease*.


Liver disease is the 5th major cause of death with 2.3 million or 5% of the UK population at risk of liver disease.
Major causes: Alcohol > 50 %, Obesity, Hep C & Hep B.


As part of a growing UK-wide effort to tackle liver disease which is now the third commonest cause of death in under 65s, the British Liver Trust has called for the Government to back universal liver health screening in primary care.
Threatening to overtake heart disease as a cause of mortality, often with no clinical presentation until significant damage has occurred. 

 

A liver biopsy is currently recognized as the ‘gold standard’ method for diagnosing and assessing liver damage, however it’s increasingly being viewed as an expensive, uncomfortable and potentially risky procedure. The need for a faster, safer and more effective method of diagnosis is more important than ever.

  

There is currently no real strategy – disease pathway
Siemens Healthineers continues to assist healthcare organizations across the globe to combat liver disease with its extensive range of solutions across the entire care pathway from diagnosis to treatment. Siemens are currently the only company to offer an integrated portfolio of solutions for managing liver health across all elements of the care pathway.

 

There are over one hundred types of liver disease. The liver is very resourceful and able to work well enough even when it may be damaged. This means that you may often not ‘present’ with clear symptoms, or show obvious sign of liver disease or illness, when you see the doctor. However, if a GP suspects a liver problem a number of tests will be carried out to provide complex information about the condition.

 

When diagnosing liver disease, some of the main tests are highlighted below:

NICE backs blood test for liver disease

Liver Disease - Ultrasound Imaging

An estimated 14 to 27 percent of the general population in the industrialized world has Non Alcoholic Fatty Liver Disease (NAFLD)1, which is often caused by obesity

 

The National Institute for Health and Care Excellence (NICE) has just issued evidence-based guidelines recommending the use of a minimally-invasive blood test to test for and monitor advanced liver fibrosis in people diagnosed with NAFLD, one of the most common types of liver disease.2 The National Health Service (NHS) and other local authorities use these guidelines to inform healthcare-related decisions.

 

The advanced, yet simple-to-conduct test is the Enhanced Liver Fibrosis (ELF) Test by Siemens Healthineers. This patient-friendly diagnostic option uses a rapid, cost-effective and minimally-invasive blood test to assess the degree of liver damage, or liver fibrosis, providing valuable clinical information. Use of the ELF Test has been established in NAFLD, as well as viral hepatitis and alcoholic patient groups.3-7

 

NAFLD is a significant risk factor in the development of liver fibrosis, which can result in cirrhosis of the liver, with often catastrophic consequences for the patient. Symptoms of cirrhosis can take between 10 to 30 years to develop, with patients often only being diagnosed at the point of end-stage cirrhosis or advanced liver cancer. Early diagnosis is key to initiating treatment to prevent the need for expensive interventions, such as liver transplants.

 

The current method of detecting liver damage is an invasive liver biopsy. This surgical procedure, which samples a tiny portion of the liver, can lead to misdiagnosis in 20% - 40% of patients8, and also carries the risk of pain and bleeding complications. Using a blood sample and mathematical algorithm, the ELF score assesses the extent of liver damage, allowing appropriate action to be taken to help prevent further damage.

 

William Rosenberg, Professor of Hepatology at UCL and the Royal Free Hospital, London, one of the primary investigators of the test states, “Liver fibrosis is asymptomatic until the late stages of cirrhosis. The major challenge for clinicians managing NAFLD is trying to detect which patients have significant liver fibrosis amongst the large numbers who do not. The ELF Test enables us to do this reliably with a simple blood test that can be included amongst routine blood tests. The ELF test can help us assess a patient, determine prognosis, and plan and monitor treatment. NICE’s endorsement of the ELF test is extremely helpful in bringing the test to the clinic and to the benefit of patients.”

 

The NICE guidelines recommend physicians “consider using the enhanced liver fibrosis (ELF) test in people who have been diagnosed with NAFLD to test for advanced liver fibrosis”, “offer retesting for advanced liver fibrosis for people with an ELF score less than 10.51 every 3 years to adults and every 2 years to children and young people,” and “consider using ELF for retesting people with advanced liver fibrosis.”

    

NICE backs Ultrasound VTQ for liver disease

Groundbreaking new ultrasound technology capable of diagnosing and monitoring liver disease without the need for biopsy has been approved for use by the NHS. The ultrasound technique, called Virtual Touch Quantification™ (VTQ) from Siemens Healthcare, assesses the stiffness of the liver based on readings from invisible, high-intensity shear waves which are transmitted through the liver.

 

The National Institute for Health and Care Excellence (NICE) has issued guidance, including cost modelling that suggests the use of VTQ could save the NHS around £434 per patient compared with a highly-invasive liver biopsy. The current gold standard method for assessing liver damage, a biopsy, involves going under local anaesthetic and a section of the liver is removed for assessment. This method only takes a small sample size from a focal area and results in a misdiagnosis in 20-40% of cases on average9.

 

VTQ uses Acoustic Radiation Force Impulse (ARFI) to provide an accurate evaluation of liver tissue stiffness, a key indicator of liver disease, through ten measurements taken across the liver. Shear waves are transmitted through the liver and attenuate approximately 10,000 times more rapidly than with conventional ultrasound. The waves travel at varying speeds through liver tissue depending on whether the liver is flexible and healthy, or stiff and damaged due to fibrous scar tissue caused by an ongoing liver condition.

 

The NICE guidance recommends VTQ for diagnosis of chronic hepatitis B or C. Liver disease is the only major cause of death still increasing year-on-year and is currently the third most common cause of premature death in the UK10. It is also estimated that up to 466,000 people have the chronic hepatitis C virus in the UK11. It is possible, however, to reverse liver disease if diagnosed at the early stages.

  

1. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4101528/
2. National Institution for Health and Care Excellence. National Clinical Guideline Centre. Non-alcoholic fatty liver disease. Assessment and management of non-alcoholic fatty liver disease (NAFLD) in adults, children and young people. December 2015.
3. Rosenberg et al., (2004) “Serum Markers Detect the Presence of Liver Fibrosis: A Cohort Study” Gastroenterology 127:1704–1713.
4. Parkes et al., (2010) “Enhanced Liver Fibrosis (ELF) Test Accurately Identifies Liver Fibrosis in Patients with Chronic Hepatitis C,” Journal of Viral Hepatitis 2011 Jan;18(1):23–31.
5. Cobbold et al., (2010) “Optimal Combinations of Ultrasound-based and Serum Markers of Disease Severity in Patients with Chronic Hepatitis C,” Journal of Viral Hepatitis 17:537–545.
6. Guha et al., (2008) “Non-invasive Markers of Fibrosis in Nonalcoholic Fatty Liver Disease: Validating the European Liver Fibrosis Panel and Exploring Simple Markers,” Hepatology 47:455–460.
7. Nobili et al., (2009) “Performance of ELF Serum Markers in Predicting Fibrosis Stage in Pediatric Non-Alcoholic Fatty Liver Disease," Gastroenterology 136:160–167.
8. https://publichealthmatters.blog.gov.uk/2014/09/29/liver-disease-a-preventable-killer-of-young-adults/

9. Poynard et al. Clin Chem 2004
10. https://publichealthmatters.blog.gov.uk/2014/09/29/liver-disease-a-preventable-killer-of-young-adults/
11. http://www.britishlivertrust.org.uk/about-us/media-centre/facts-about-liver-disease/
 

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