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NETWORK A national newsletter on substance misuse management in primary care network NETWORK 33 NOVEMBER 2011 Liver special edition


SMMGP is becoming increasingly concerned about the rise in liver disease in the UK and we are pleased to bring you this special edition on the liver. People using drugs and alcohol are at particular risk of liver disease, and in this edition of Network we aim to provide the knowledge to better diagnose, refer and support the treatment of this growing problem.


predicted to double in the next 20 years. Despite this looming crisis it has to be remembered that the three main causes of liver disease − alcohol, obesity and blood borne infections, in particular hepatitis B and C – are all preventable and treatable.


Liver disease: a ticking time bomb


Liver disease in the UK is killing more people than diabetes and road deaths combined; it is the fifth biggest cause of death in England and Wales, after heart disease, cancer, stroke and respiratory disease1


of death is reducing in the UK except for one: liver disease. A total of 16,087 people died from liver disease in 2008, and if the rate continues at its current pace, deaths from liver disease are


1 Office for National Statistics: Health Service Quarterly, Winter 2008, No. 40 p59-60 . The rate of death in all these major causes


People dying from liver disease die young: the average age of death is 59 − and this average age is falling − as compared to over 70 for the other major killers2


“there can be a lack of confidence ”


about liver disease in primary care, leading to a failure to both prevent and diagnose problems


. People with liver disease tend


to be ill for 3-5 years before death. However for many the period of illness is longer and the social and economic cost is significant. A typical patient will have 5-10 hospital admissions before dying. Around 700 people will receive a liver transplant, and this number is rising. Some have calculated that the cost of liver disease could be as high as 1 billion by 2015. As with so many other conditions, health inequalities compound the problem, with socially excluded populations experiencing higher levels of liver disease.


And yet there can be a lack of confidence about liver disease in primary care, leading to a failure to both prevent and diagnose problems. One difficulty with diagnosis is that liver disease is often


2 A joint response on behalf of liver disease clinicians and patients by British Association for the Study of the Liver (BASL), British Liver Trust (BLT) and British Society of Gastro- enterology (BSG) to the White Paper ‘Equity and Excellence: Liberating the NHS’


…continued overleaf In this issue


Jude Oben and colleagues run through the basics of non alcoholic fatty liver disease. Page 3


Carsten Grimm gives some hints and tips on how to diagnose alcohol related liver disease. Page 4


Helen’s story of how her GP missed her symptoms of hepatitis C is an important reminder about diagnosis in Living with HCV and Euan Lawson goes on to give some useful tips on diagnosis. Page 5


Euan Lawson gives some practical suggestions about finding cases of hepatitis B and C on page 6, and discusses the ins and outs of hepatitis A and B immunisations. Page 7


Graham Foster and Morven Cunningham give us a glimpse into the future in their article What’s new on the horizon for treatment of hepatitis C? Page 8


Brian Thompson gives some detail on factors that lead to progression of liver disease for those with hepatitis. Page 10


Martin Lombard, National Clinical Director for Liver Disease who is tasked with developing the liver strategy outlines some of the issues in a briefing paper. Page 11


Iain Brew takes us through the ways in which we can support people going through treatment for hepatitis C. Page 12


Dr Fixit Mark Hallam gives advice to a GP on how to support people who are in hepatitis treatment. Page 13


Steve Brinksman is Dr Fixit to a GP with a patient with hepatitis C who is overweight and drinking alcohol, and suggests that there is a lot primary care can do limit harm to the liver and to prepare people for treatment. Page 14


See all the latest courses and events. Page 16. We hope you enjoy this edition. Editor


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