Community pathways for the early detection and risk stratification of chronic liver disease: a narrative systematic review

Abeysekera, Kushala; Macpherson, Iain; Glyn-Owen, Kate; McPherson, Stuart; Parker, Richard; Harris, Rebecca; Yeoman, Andrew D.; Rowe, Ian; Dillon, John

doi:10.1016/s2468-1253(22)00020-6

Cited by 21 publications

(19 citation statements)

References 41 publications

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“…(5)(6)(7)(8) Furthermore, in studies that performed cost-effectiveness analyses, benefit over "standard of care" was demonstrated. (6,9,10) This was further supported by costcomparison modelling of different strategies for detection fibrosis, supporting a twostep risk stratification model (11), now incorporated in international guidance. (12) There are many unanswered questions.…”

Section: Promentioning

confidence: 71%

“…Even in NAFLD, historically considered a slowly progressing fibrotic process,10 trial data has demonstrated over a fifth of patients with nonalcoholic steatohepatitis and F3 fibrosis progressed to cirrhosis within 2 years 11. Furthermore, in studies that performed cost-effectiveness analyses, benefit over ‘standard of care’ was demonstrated 7 12 13. This was further supported by cost-comparison modelling of different strategies for detection fibrosis, supporting a two-step risk stratification model,14 now incorporated in international guidance 15…”

Section: Promentioning

confidence: 91%

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#FGDebate: Should we focus on detecting patients at risk of liver disease in the community?

Abeysekera

Shearer

Tavabie

et al. 2022

Frontline Gastroenterol

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Section: Promentioning

confidence: 71%

Section: Promentioning

confidence: 91%

#FGDebate: Should we focus on detecting patients at risk of liver disease in the community?

Abeysekera

Shearer

Tavabie

et al. 2022

Frontline Gastroenterol

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“… 1 There is currently no widely recognised approach to detect liver disease in the community and several strategies have been suggested, but the optimum approach remains unknown. 10 Therefore, the main aim of this study is to assess the efficacy of two pathways to detect advanced liver fibrosis among patients at increased risk of fatty liver disease in primary care. Data collected will allow us to evaluate the performance of current and novel liver fibrosis biomarkers in this setting and develop effective pathways for widespread implementation.…”

Section: Discussionmentioning

confidence: 99%

“…Because stage of liver fibrosis is the key prognostic factor in liver disease,8 use of a test for fibrosis is likely to be far more efficient to identify advanced fibrosis. Therefore, taking a different approach and performing case finding using non-invasive tests to identify advanced liver fibrosis in individuals with liver disease risk factors may be an effective strategy 9 10…”

Section: Introductionmentioning

confidence: 99%

Stratification Of LIver Disease (SOLID): protocol for a prospective observational cohort study to determine the optimum biomarker strategies for the detection of advanced liver disease at the primary–secondary care interface

McPherson

Jarvis

McGonigle³

et al. 2023

BMJ Open Gastroenterol

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IntroductionUndiagnosed fatty liver disease is prevalent in the community, due to high rates of harmful alcohol consumption and/or obesity. Fatty liver disease can progress to cirrhosis and its complications. Early identification of liver disease and treatment may prevent progression to cirrhosis. Biomarkers including FIB-4, enhanced liver fibrosis (ELF), PRO-C3 and vibration controlled transient elastography (VCTE) can stage liver fibrosis, but it is not known how well they perform in a primary care population. Moreover, no assessment of long-term prognostic ability of these biomarkers has been conducted in primary care. We aim to evaluate the performance of fibrosis biomarkers in primary care to develop a pathway to detect advanced fibrosis.Methods and analysisThis prospective, observational cohort study will recruit 3000 individuals with fatty liver disease risk factors (obesity, type 2 diabetes or hazardous alcohol consumption) at their primary care ‘annual chronic disease review’. Participants will have a ‘liver health check’. Two pathways will be evaluated: (1) all have FIB-4, ELF and VCTE performed, and (2) patients have an initial assessment with FIB-4 and ELF, followed by VCTE in only those with increased FIB-4 and/or ELF. Individuals with suspected significant/advanced liver fibrosis (liver stiffness measurement>8 kPa), will be reviewed in secondary care to confirm their fibrosis stage and institute treatment. The performance of FIB-4, ELF, PRO-C3, VCTE and novel biomarkers alone or in combination for advanced fibrosis/cirrhosis will be evaluated. Participants will be followed longitudinally via their electronic health records to assess long-term clinical outcomes.Ethics and disseminationEthical approval was obtained from the London-Chelsea Research Ethics Committee (22/PR/0535; 27 June 2022). Recruitment began on 31 October 2022. Outcomes of this study will be published in peer-reviewed journals and presented at scientific meetings. A lay summary of the results will be available for study participants and will be disseminated widely by LIVErNORTH.

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“…NAFLD is not a status, but rather a stage of conditions including liver steatosis and non-alcoholic steatohepatitis (NASH), all the way up to cirrhosis and hepatocellular carcinoma [ 1 ]. Liver fibrosis is a key factor for liver-related, and all-cause, mortality [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

Farnesoid X Receptor, Bile Acid Metabolism, and Gut Microbiota

et al. 2022

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Obesity, type 2 diabetes, and non-alcoholic fatty liver disease (NAFLD) are characterized by the concepts of lipo- and glucotoxicity. NAFLD is characterized by the accumulation of different lipidic species within the hepatocytes. Bile acids (BA), derived from cholesterol, and conjugated and stored in the gallbladder, help the absorption/processing of lipids, and modulate host inflammatory responses and gut microbiota (GM) composition. The latter is the new “actor” that links the GI tract and liver in NAFLD pathogenesis. In fact, the discovery and mechanistic characterization of hepatic and intestinal farnesoid X receptor (FXR) shed new light on the gut–liver axis. We conducted a search on the main medical databases for original articles, reviews, meta-analyses of randomized clinical trials, and case series using the following keywords, their acronyms, and their associations: farnesoid X receptor, bile acids metabolism, gut microbiota, dysbiosis, and liver steatosis. Findings on the synthesis, metabolism, and conjugation processes of BAs, and their action on FXR, change the understanding of NAFLD physiopathology. In detail, BAs act as ligands to several FXRs with GM modulation. On the other hand, the BAs pool is modulated by GM, thus, regulating FXRs functioning in the frame of liver fat deposition and fibrosis development. In conclusion, BAs passed from their role of simple lipid absorption and metabolism agents to messengers between the gut and liver, modulated by GM.

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Community pathways for the early detection and risk stratification of chronic liver disease: a narrative systematic review

Cited by 21 publications

References 41 publications

#FGDebate: Should we focus on detecting patients at risk of liver disease in the community?

#FGDebate: Should we focus on detecting patients at risk of liver disease in the community?

Stratification Of LIver Disease (SOLID): protocol for a prospective observational cohort study to determine the optimum biomarker strategies for the detection of advanced liver disease at the primary–secondary care interface

Farnesoid X Receptor, Bile Acid Metabolism, and Gut Microbiota

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