NHS pilot program detects liver diseases in asymptomatic patients

Hundreds of individuals have been diagnosed with liver diseases through what is considered a pioneering NHS mass screening pilot globally. This £1.4 million initiative in Somerset involved analyzing blood samples from 700,000 people over the age of 18 for indicators of liver disease, leading to the identification of approximately 700 patients with conditions. The innovative tool examines historical medical data to pinpoint those at risk of developing problems, subsequently inviting them for a scan before symptoms emerge. Brian McHugh, 70, from Taunton, was one such patient identified, remarking that it was “better to find out sooner rather than later.” Chronic liver diseases frequently progress without symptoms, meaning that individuals often first consult a doctor in an emergency situation when treatment options are limited. The delayed detection of chronic liver disease increases the likelihood of complications such as liver cancer, liver failure, and the necessity for transplants. Dr. Tim Jobson, who contributed to the development of the new screening tool, stated: “The pattern that suggests in five or ten years time they are going to have a problem – we can see them now. We can see them early, we can treat them or they can change their lifestyle, whatever they need to do in order to not end up having advanced liver disease. That includes liver disease from viral disease, inherited problems, immune disease as well as the more common ones such as fatty liver disease and alcohol.” The new tool’s inception followed Dr. Jobson, a liver consultant in Taunton, expressing his concerns about undiagnosed liver disease to a healthcare IT expert in 2019. They collaborated with Somerset NHS Foundation Trust and secured funding from the National Institute for Health Research to create a solution, which culminated in the launch of Predictive Health Intelligence (PHI), an enterprise partially owned by the NHS. PHI subsequently developed hepatoSIGHT, a case-finding tool designed to utilize the extensive historical medical data accumulated over decades. Clinicians at the Somerset trust employ this tool to identify individuals who may be at risk of liver disease, based on their past test results. Once a group of patients is identified by the clinical team, the Trust sends them letters inviting them for a review of their liver health, thereby enabling them to receive treatment sooner. Mr. McHugh mentioned his bewilderment upon receiving an unexpected letter, as he had “no symptoms.” Two weeks later, Mr. McHugh attended an appointment for an ultrasound and was eventually diagnosed with primary biliary cholangitis, an autoimmune disease affecting the liver. This condition can be managed with medication to prevent the need for a transplant. The 70-year-old commented: “Initially I was a bit concerned. It seemed there was something not quite right health wise, but I was keen to follow it up and find out what we are dealing with. I am sure this would be something that would have come to light with some rather more serious health implications later on. How long that might have taken I don I know. It was something better to find out sooner rather than later.” Dr. Ahmed Elsharkawy from the British Liver Trust characterized the screening as “interesting.” He added: “The fact that it is automated is a big advantage. Obviously it’s still relying on people having had blood tests so it may miss those who have not had blood tests. But it is undeniable that because liver disease has no symptoms you need to rely on some form of screening. We will only see the benefit in the long term. This is the first iteration of hopefully more sophistic systems coming downstream.” PHI is currently engaged in discussions regarding further implementations of hepatoSIGHT, with plans to broaden its coverage to the entire population of the south west of England. Dr. Jobson further stated: “Adoption across the NHS of course would be what we are aiming for because it has the ability to impact many thousands of patients across the NHS . The data is already there, it is just finding those patients.”