Non-Alcoholic Fatty Liver Disease, a sleeping giant among the community, is already growing to epidemic proportions and will have major impacts on our health system without greater intervention.
What if you could use technology to identify that sleeping giant before it grew more dangerous? A collaborative FibroScan project with PA Hospital based hepatologist Professor Elizabeth Powell and QIMR Berghofer Institute Epidemiologist Professor Patricia Valery intends to do just that.
Affecting 5.5 million Australians and rising due to increased prevalence of obesity and type 2 diabetes, the need for early identification of fatty liver with severe scarring is incredibly important, especially considering the condition can lead to cirrhosis, liver failure, and liver cancer.
The project titled 'Local Assessment and Triage Evaluation of Non-alcoholic Fatty Liver Disease', which includes Queensland University of Technology NHMRC Senior Research Fellow, Professor Adrian Barnett, and Sunshine Coast-based Hepatologist Professor James O'Beirne, aims to transform the assessment of fatty liver disease using a FibroScan machine.
FibroScan testing provides a quick and painless way to assess liver scarring through ultrasound technology.
The portable machine, which can also assess scarring due to alcohol related liver injury and hepatitis B and C virus infection, requires an M probe valued at $35,000 (or an XL probe for larger patients) to measure liver stiffness. This is where PA Research Foundation aided the project's advancement, through acquiring the M probe via a Queensland government Gambling and Community Benefit grant - a contribution Professor Powell is highly grateful for.
"We'd secured other funding to buy the hardware, but we couldn't purchase the probe. Without PA Research Foundation's support, the project wouldn't be possible," Prof Powell said.
PA Hospital based hepatologist Professor Elizabeth Powell
"The probe sends a signal through the liver that assesses the hardness or "stiffness" of the liver. The liver stiffness measurement provides us with an assessment of the extent of liver scarring or fibrosis, and whether advanced scarring or cirrhosis is present. People with advanced liver scarring may need to be seen in a liver clinic, for further assessment and monitoring of liver disease.
"Non-alcoholic fatty liver disease tends to slip under the radar. Most doctors use liver enzymes as a way of monitoring liver disease, but these can be misleading in fatty liver disease. Liver tests can be normal in more than 50% of people with fatty liver disease, and they correlate poorly with the severity of liver disease.
"That's why we need this new technology which allows us to assess liver stiffness, as a measure of liver fibrosis."
The project will start recruiting patients in September and hopes that earlier identification of people with less advanced liver disease will mean they can be treated at the local level by their GP, with interventions such as a healthy diet and increased physical activity.
"What we're focusing on is trying to identify that subgroup of patients at risk of developing advanced liver disease, because they're the group that we need to see in our liver clinics," Professor Powell said.
Professor Valery said once trials are completed, the collaborators would love to see FibroScan testing rolled out to regional communities via an outreach service run by a trained nurse, with the lower risk patients identified and then treated by their local doctors and higher risk patients being prioritised for liver clinics.
QIMR Berghofer Institute Epidemiologist Professor Patricia Valery
"It will be cheaper for patients and it will be easier as they don't have to travel; it will be faster as well, because the waitlist would be a lot shorter for just the FibroScan, than if you refer a patient to see a specialist," she said.
"We want patients to be assessed very early outside the hospital system. Most patients are fine, they have very early liver disease and they don't need to see the specialist in the liver clinic. It's a win-win for patients and the health system if we can assess them using the FibroScan."
With 30% of the Australian population affected, the researchers feel awareness of the rising rates of non-alcoholic fatty liver disease needs to increase.
"What we're seeing is people with fatty liver disease present to hospital at a later stage of the disease - we're seeing people present for the first time with cirrhosis or complications of cirrhosis, such as liver cancer," Professor Powell said.
"This is concerning, because if we identify that a person with fatty liver disease has advanced liver scarring or cirrhosis, we would recommend that they are enrolled in a surveillance program with a liver ultrasound performed every six months to screen for liver cancer. Because if we can identify liver cancer at an early stage, we have more treatments available to manage and treat it, whereas if people present late with liver cancer, that really limits our treatment options, and the success of therapy.
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