Optimising referral pathways for patients with non-alcoholic fatty liver disease in the UK

The increasing burden of non-alcoholic fatty liver disease means that robust clinical pathways need to be established in primary care to identify patients with advanced fibrosis who may benefit from specialist management. This article summarises the current landscape of non-invasive liver fibrosis tests and discusses the outcomes and lessons learned from non-alcoholic fatty liver disease pathways that have been instigated around the UK. The inherent challenges of implementing such pathways are explored, along with developing technologies, such as artificial intelligence blood testing, which will likely play an important role in helping to identify and risk-stratify more patients with non-alcoholic fatty liver disease in primary care in the future.

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Performance of non-invasive fibrosis tests among non-alcoholic fatty liver disease (NAFLD) patients with normal alanine aminotransferase (ALT): data from a large North American primary care NAFLD pathway

Journal of Hepatology ◽

10.1016/s0168-8278(20)31291-5 ◽

2020 ◽

Vol 73 ◽

pp. S403

Author(s):

Abdel-Aziz Shaheen ◽

Stephen Congly ◽

Wendy Schaufert ◽

Kelly Burak ◽

Alexandra Medellin ◽

...

Keyword(s):

Primary Care ◽

Liver Disease ◽

Fatty Liver ◽

North American ◽

Alanine Aminotransferase ◽

Fatty Liver Disease ◽

Alcoholic Fatty Liver ◽

Non Invasive ◽

Normal Alanine Aminotransferase ◽

Alcoholic Fatty Liver Disease

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Non-invasive assessment of fibrosis in non-alcoholic fatty liver disease predicts cardiovascular risk in a large screening cohort

Zeitschrift für Gastroenterologie ◽

10.1055/s-0035-1551776 ◽

2015 ◽

Vol 53 (05) ◽

Author(s):

D Niederseer ◽

A Stadlmayr ◽

U Huber-Schönauer ◽

D Lederer ◽

W Patsch ◽

...

Keyword(s):

Cardiovascular Risk ◽

Liver Disease ◽

Fatty Liver ◽

Fatty Liver Disease ◽

Alcoholic Fatty Liver ◽

Non Invasive ◽

Alcoholic Fatty Liver Disease

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Non-Invasive Distinction of Non-Alcoholic Fatty Liver Disease using Urinary Volatile Organic Compound Analysis: Early Results

Journal of Gastrointestinal and Liver Diseases ◽

10.15403/jgld.2014.1121.242.ury ◽

2015 ◽

Vol 24 (2) ◽

pp. 197-201 ◽

Cited By ~ 10

Author(s):

Ramesh P. Arasaradnam ◽

Michael McFarlane ◽

Emma Daulton ◽

Erik Westenbrink ◽

Nicola O’Connell ◽

...

Keyword(s):

Liver Disease ◽

Pilot Study ◽

Fatty Liver ◽

Fatty Liver Disease ◽

Diagnostic Methods ◽

Screening Methods ◽

Alcoholic Fatty Liver ◽

Non Invasive ◽

Volatile Organic ◽

Alcoholic Fatty Liver Disease

Background & Aims: Non-Alcoholic Fatty Liver Disease (NAFLD) is the commonest cause of chronic liver disease in the western world. Current diagnostic methods including Fibroscan have limitations, thus there is a need for more robust non-invasive screening methods. The gut microbiome is altered in several gastrointestinal and hepatic disorders resulting in altered, unique gut fermentation patterns, detectable by analysis of volatile organic compounds (VOCs) in urine, breath and faeces. We performed a proof of principle pilot study to determine if progressive fatty liver disease produced an altered urinary VOC pattern; specifically NAFLD and Non-Alcoholic Steatohepatitis (NASH).Methods: 34 patients were recruited: 8 NASH cirrhotics (NASH-C); 7 non-cirrhotic NASH; 4 NAFLD and 15 controls. Urine was collected and stored frozen. For assay, the samples were defrosted and aliquoted into vials, which were heated to 40±0.1°C and the headspace analyzed by FAIMS (Field Asymmetric Ion Mobility Spectroscopy). A previously used data processing pipeline employing a Random Forrest classification algorithm and using a 10 fold cross validation method was applied.Results: Urinary VOC results demonstrated sensitivity of 0.58 (0.33 - 0.88), but specificity of 0.93 (0.68 - 1.00) and an Area Under Curve (AUC) 0.73 (0.55 -0.90) to distinguish between liver disease and controls. However, NASH/NASH-C was separated from the NAFLD/controls with a sensitivity of 0.73 (0.45 - 0.92), specificity of 0.79 (0.54 - 0.94) and AUC of 0.79 (0.64 - 0.95), respectively.Conclusions: This pilot study suggests that urinary VOCs detection may offer the potential for early non-invasive characterisation of liver disease using 'smell prints' to distinguish between NASH and NAFLD.

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