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Earlier diagnosis to identify patients at risk from liver disease is needed to tackle a rising tide of the disease, according to the findings of a new Lancet Commission, which includes input from experts at Nottingham’s NIHR Biomedical Research Centre (BRC).

Nearly 780 people die from cirrhosis or liver cancer every day in Europe - conditions which are largely preventable.

A major new report from the EASL (European Association for the Study of the Liver) –Lancet Commission on Liver Health in Europe warns that liver disease is an escalating public health crisis across the World Health Organization European Region. It also provides a roadmap for improving liver healthcare across Europe.

One of the report’s key recommendations is earlier detection of liver disease, along with joined-up care for people who often have multiple health conditions – areas where Nottingham’s scientists and clinicians have shown innovation.

Professor Neil Guha, Co-Lead for Nottingham BRC’s Gastrointestinal and Liver research theme, is one of the authors of the EASL-Lancet commission report and worked as Co-chair of its Healthcare Pathway. He also led the Scarred Liver project which introduced the concept of an integrated pathway across primary and secondary care.

He said: “Liver disease is one of the biggest health burdens across Europe and has now reached the status of an escalating public health crisis.

“The EASL-Lancet Commission’s second report on liver disease makes for stark reading. We have found that cirrhosis and liver cancer together account for approximately 284,000 deaths annually in Europe, and liver cancer mortality has increased by over 50% since 2000.

“What is also of great concern is that liver disease remains among the few non-communicable diseases which are still growing, even though Europe has made progress against conditions like heart disease and cancer.”

Significant contribution to early diagnosis

Professor Guha, who is also a Consultant Hepatologist at Nottingham University Hospitals NHS Trust, added: “There is clearly a huge amount of work to be done urgently, but here in Nottingham we have made a significant contribution to early diagnosis of liver disease.

“This gives people the chance to make lifestyle changes to reverse the damage which improves their health and, consequently, saves NHS resources.

“We have worked closely with clinical colleagues at Nottingham University Hospitals NHS Trust (NUH), to develop innovative pathways of care. This allows patients with the highest risk of developing liver disease to be identified.”

Since 2022, in work led by consultant hepatologist Dr Rebecca Harris at NUH, the integrated pathways have evolved to address health inequity to actively find patients in areas of high deprivation using population health databases.

This work has fed directly into the Lancet Commission and will help to influence the next iteration focused on looking after long-term conditions associated with chronic liver disease.

Development of this pathway by the Nottingham BRC researchers and clinicians has won recognition with an award from the Health Service Journal and a National Innovation Challenge Prize; with recognition from national bodies including NICE, King’s Fund, the Royal College of General Practitioners and British Society of Gastroenterology.

• The Commission’s second report, From Evidence to Impact: Implementing Sustainable Liver Health in Europe, finds that cirrhosis and liver cancer together account for approximately 284,000 deaths annually in Europe. Liver cancer mortality has increased by more than 50% since 2000 — from around 43,000 deaths to approximately 69,000 in 2023. Crucially, liver disease remains one of the few major non-communicable diseases still growing, even as Europe has made progress against conditions like heart disease and cancer.
• The full report can be found at: https://www.thelancet.com/commissions-do/europe-liver-health