NAFLD Non-Alcoholic Fatty Liver Disease NASH Non-Alcoholic Steato-Hepatitis.
Screening for alcoholic liver disease
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Screening for alcoholic liver disease Dr Richard Aspinall Consultant Hepatologist Portsmouth Hospitals NHS Trust
Transcript of Screening for alcoholic liver disease
Screening for alcoholic liver disease
Dr Richard AspinallConsultant Hepatologist
Portsmouth Hospitals NHS Trust
NHS Portsmouth
The majority of our alcohol-related admissions are for chronic complications such as cirrhosis
Liver deaths in Portsmouth 1993-2008Mortality rate for chronic liver disease including cirrhosis (ICD10 K70, K73-K74) for personsPortsmouth, England and South East England, 1993 to 2008Source: NCHOD. Compendium of Clinical and Health Indicators
Linear trend equation: y = 0.4344x + 7.3905
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1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
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South East GOR
Portsmouth UA
Linear (Portsmouth UA)
Pathogenesis of alcoholic liver injury
Clustering of risk factors for liver cirrhosis
• Poor socio-economic status• Alcohol misuse• Obesity• Chronic viral hepatitis – esp HCV
Determinants of health
Dahlgren G &Whitehead M. Policies and strategies to promote social equity in health. Stockholm: Institute for Future Studies 1991
Public health: The social gradient
Influence of obesity and alcohol intake on deaths from liver disease in Scotland
Hart CL et al. BMJ 2010Alcohol > 15 units / week BMI > 30 Scottish Midspan cohort study of 9559 men from 1965-1987
Corrao G, Lepore AR, Torchio P, et al: Eur J Epidemiol 1994; 10:657
Alcohol + Hepatitis C = More cirrhosis
Liver fibrosis: Alcohol is different to other aetiologies
• Fibrosis in alcoholic liver disease is more dynamic than in other liver disorders
• Fibrosis in ALD is more affected by individual factors– Age, gender, type / quantity of drinking– Genetic variation
• Alcohol withdrawal usually leads to rapid clinical improvement but not to rapid fibrosis regression
What does a liver biopsy add?
• Diagnosis – but cannot distinguish ALD from NAFLD/NASH
• Staging – eg acute alcoholic steatohepatitis versus decompensated cirrhosis
• Prognostic information– But functional tests are better – Child’s-Pugh,
MELD, HVPG, etc• Diagnosis of cirrhosis to implement screening
for HCC, varices, etc– Probably the major indication in 2012
Accuracy of non-invasive fibrosis markers in 541 NAFLD patients
Test AUROC 95% CI
Fib-4 0.802 0.75-0.84
Angulo 0.768 0.72-0.82
AST:ALT 0.742 0.69-0.79
APRI 0.730 0.68-0.77
AST:Plts 0.720 0.67-0.77
Shah AG et al. Clin Gastroenterol Hepatol. 2009;7:1104-12
FIB4 > or = 2.67 gives 80% positive predictive value FIB4 < or = 1.30 gives 90% negative predictive value
Non-invasive serum markers
• Can be cheap• Acceptable to patients• Most accurate at predicting no or
minimal fibrosis• Less accurate in intermediate range• Less accurate in ALD versus other dis• Influenced by active inflammation
Screening for alcoholic liver disease - summary
• Higher risk groups– Drinking patterns– Obesity– Comorbidities eg HCV
• Clues from blood tests• FibroScan potentially useful – after detox
www.porthosp.nhs.uk
Richard AspinallConsultant Hepatologist
Dept of Gastroenterology & HepatologyQueen Alexandra Hospital
Portsmouth PO6 3LY
