Intended for healthcare professionals


How to tackle rising rates of liver disease in the UK

BMJ 2013; 346 doi: (Published 08 February 2013) Cite this as: BMJ 2013;346:f807
  1. Neeraj Bhala, specialist registrar in gastroenterology and liver medicine1,
  2. Guruprasad Aithal, professor of hepatology2,
  3. James Ferguson, consultant hepatologist1
  1. 1Liver Unit, Queen Elizabeth Hospital, University Hospital Birmingham NHS Trust, Birmingham B15 2TH, UK
  2. 2NIHR Biomedical Research Unit in Gastrointestinal and Liver Disease, Nottingham University Hospitals NHS Trust, Nottingham, UK
  1. nijbhala{at}

All health professionals must strive to detect risk factors for liver disease and intervene early to manage them

The new chief medical officer for England’s first annual report in November 2012 highlighted that liver disease is a growing clinical burden and public health priority in the United Kingdom.1 Although death from liver disease is decreasing in other European populations, deaths from chronic liver disease and cirrhosis in the under 65s in England increased by around 20% from 2000 to 2009, making it the fifth leading cause of death (fig 1). Because the major drivers of increasing liver disease are all potentially preventable (particularly high alcohol consumption, but also obesity and chronic hepatitis B and C infection), comprehensive action is clearly needed to deal with the problem.

Deaths caused by liver disease in under 65s. EU=European Union member countries before 20042 3

What can healthcare practitioners do to help stem the rising tide of liver disease? The best way to promote optimum liver health is to facilitate behavioural change in those at risk. Every clinical encounter can be used—for example, to screen for alcohol use disorders or to look proactively for early signs of liver disease (rather than assuming that this is another stakeholder’s responsibility).

The current recommended upper …

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