Liver disease is the third commonest cause of early death in the UK, and the number of people with the disease is growing. The main causes, alcohol, obesity and viral hepatitis are well known, but many people show no signs of illness until irreversible liver damage and scarring (cirrhosis) have developed.
One in four patients are not diagnosed until they are admitted to hospital with advanced disease, when it is too late to prevent further damage. With so many people dying from liver disease, providing good end of life care is crucial. The symptoms of terminal liver disease are often difficult to treat, but few patients see a palliative care specialist, and a high proportion die in hospital.
Urgent action is needed, to improve care for patients with liver disease in primary care. General practitioners have a particularly important part to play at the beginning and end of the illness; identifying patients who need further tests, treating symptoms, and making sure that palliative care is in place. We know that current blood tests are not very good at identifying people at risk of serious liver disease, and that the results are difficult to interpret. In addition, other reasons why primary care for these patients may not be effective need to be explored.