Who Will Guide 100M People?

With an estimated 25%-30% of the population having fatty liver disease, it will not be possible to screen everyone. How will 'at risk' patients who may progress to more serious liver disease, be identified? Who needs to be referred to a liver specialist?

Is there an easy way to identify and refer patients who are at risk?

At the moment, the answer is no.

There are a number of available and often used tests, being used more and more in combination, to identify more advanced liver disease.

1. There are blood tests: Alanine transaminase (ALT) and aspartate transaminase (AST), albumin, bilirubin level, creatinine, prothrombin time and sodium. Physicians may also do a complete blood count (CBC).
2. There are imaging tests: CT scan (computed tomographic), MRI, ultrasound, endoscopy, Ultrasound elastography (Fibroscan) and transient elastography.
3. Finally, there is the more invasive, but still gold standard, biopsy.

Non-invasive technologies (NITs) may be the winner for patients, outside of clinical studies. They are less expensive, less dangerous to the patient, and have a faster recovery time.

Sounds easy enough, so what is the problem?

Liver specialists do not have the time to screen the general population for patients who have fatty liver disease and are most likely to develop fibrosis, cirrhosis, liver cancer and possibly death. So, whose role will it be? For now, it sounds like the Family Practice Physician will need to be the conduit to the liver specialists.

Where can Family Practice Physicians start?

Patients that are obese and/or have diabetes type 2 are at a significantly higher risk of fatty liver disease that may progress.

Dr. Mark Swain, in this video shares how important having the right tools are for Physicians to pick out the highest risk patients. He shares that, "sometimes it might be 30% of their practice that has fatty liver disease, and they know it. They just don't know who those people are who needs a liver specialist. A lot of times, they don't know what to do, so they don't do anything about it."

In just the US and Canada, an estimated 100M people have fatty liver disease. About 20% of those people will develop more advanced liver disease. We need to arm Family Practice Physicians with everything they need to support their patients. Every patient is unique and not all patients will need to be referred to a liver specialist. In fact, treating more advanced fatty liver disease may require multi-disciplinary intervention; Hepatologists, Endocrinologists, Cardiologists, Nutritionists, and counselling.

"A good physician treats the disease, the great physician treats the patient who has the disease.”