Non-alcoholic fatty liver diseaseBMJ 2009; 339 doi: https://doi.org/10.1136/bmj.b2474 (Published 16 July 2009) Cite this as: BMJ 2009;339:b2474
All rapid responses
The article on non alcoholic fatty liver disease by Bhala, Usherwood
and George (1) is unsatisfactory for a number of reasons.
Firstly it does not mention an extremely important cause of abnormal liver
function tests i.e. Hereditary Haemochromatosis (HH). While they did say
that tests excluded other forms of liver dysfunction, they did not specify
what these tests were. It is estimated that about 0.4% of people of white
northern European ancestory homozygous for C282Y mutation in the HFE gene,
and most of these will develop iron overload (2). This means that in the
average GP practice there may be 8 such people. Often they may have co-
existing causes for their abnormal LFTs.
Secondly I hate the vague term etc. If this article is meant to
inform busy clinicians as to how they are to deal with such patients, this
must be avoided and the details of appropriate investigations spelt out.
Here in the Mid-West of Ireland, our consultant gastroenterologist has
requested that the following blood tests are carried out prior to referral
in the case of persistent abnormalities in LFTs:
Serum ferritin, transferrin saturation (haemochromatosis gene
analysis if abnormal)
Autoantibody levels (ANA, ASMA, AMA)
Access to ultrasound is variable.
Ray O'Connor MB FRCGP, MICGP
1. Bhala N. Usherwood T. George J. Practice. 10-minute consultation. Non-
alcoholic fatty liver disease. BMJ 2009;339:b2474
2. Cayley WE. 10 Minute Consultation; Haemochromatosis. BMJ
Competing interests: No competing interests