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GPs need new liver function guidance say experts

By Nigel Praities

Patients with abnormal liver function tests picked up in primary care are not being followed up because of a lack of clear referral guidance, experts warn.

A new study finds GPs are not routinely employing cautionary measures such as tests for underlying disease or referrals to specialist treatment in the event of a raised liver function test.

The research, presented at the British Society of Gastroenterology annual meeting in Birmingham last week, found screening for underlying viral, metabolic or autoimmune liver disease was only requested in 12% of the 172 cases analysed.

Hepatitis A, B and C serology was requested in only 16%, 35% and 32% of patients respectively. Only 15% of patients were referred to a specialist and only around a fifth of patients received lifestyle advice.

The researchers, from Queen Mary's Hospital in Sidcup, said improvements were needed in the response to abnormal tests. ‘Implementation of guidelines for the evaluation of abnormal liver function tests in primary care should be considered,' they concluded.

Dr Richard Stevens, a GP in Oxford and chair of the Primary Care Gastroenterology Society, said abnormal liver function tests were an increasing and ‘genuine problem' in general practice – and that GPs needed better advice.

‘There is no doubt that we are doing more tests and turning up more abnormalities. What we need is a pathway or an algorithm, to show what we need to do in certain circumstances,' he said.

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