Changing the paradigm for liver disease - Nick Sheron

19701972

19741976

19781980

19821984

19861988

19901992

19941996

19982000

20022004

20062008

20100

20

40

60

80

100

120Percentage change in standardised UK mortality rates (age 0-64) normalised to 100% in 1970

circulatoryischaemic heartcerebrovascularneoplasmsrespiratoryendocrine / metabolicdiabetes

Years

%

Data from WHO-HFA database downloaded Oct 2013

19701972

19741976

19781980

19821984

19861988

19901992

19941996

19982000

20022004

20062008

20100

100

200

300

400

500

600Percentage change in standardised UK mortality rates (age 0-64) normalised to 100% in 1970

circulatoryischaemic heartcerebrovascularneoplasmsrespiratoryliverendocrine / metabolicdiabetes

Years

%

Data from WHO-HFA database downloaded Oct 2013

Sheron, Gilmore BMJ 2015 in press

Liver mortality Directly attributable alcohol mortality

Williams et al Lancet 2015

050

100

150

200

250

300

350

400

450

500

Trends in mortality from alcohol related liver disease in England and Wales , con-sumption of spirits, wine, beer and cider, and changes in duty

Alcohol related liver deaths E&W %

White spirits consumption %

Whisky con-sumption %

Cider consumption %

Wine consumption %

Total lager / beer consumption al-cohol %

Packaged strong lager %

% c

hang

e sin

ce 1

980

Dr Foster data, in-hospital mortality all E &W acute trusts

Nick Sheron, unpublished analysis

Survival of admissions to the Liver Unit Southampton

1/3

1/3

1/3

76%

P<0.001

Prior liver outpatient referrals in 5,112 Southampton first admissions with cirrhosis

Nick Sheron unpublished analysis

¾ of people who will die of cirrhosis have no idea they are ill

Population Hepatology

Liver cell

Liver Enzymes

eg ALT, AST, ALP, GGT

Necrosis = cell swells, membrane leaks,enzymes escape

Liver enzymes are raised in blood

Viral hepatitis

Autoimmune hepatitis

necrosis apoptosis

Cell shrinks with membrane intact

necrosis apoptosis

Liver enzymes normalAlcoholObesity

Scarring or fibrosis

The current system for treating liver disease doesn’t work

Because it picks up people too late

The Southampton Liver Traffic Light Test

4,343 subjects followed for 12 years

30% reduced drinking to safe levels

65% reduced drinking to safe levels

Traffic light test given to 400 heavy drinkers in primary care

follow up data at one year

The POLeMIC program Prevention

OfLiver MortalityIn Communities

Confidential Unpublished Data

Emma Greatorex, Katie Minards, David Cable, Alan Hales

Biochemistry data

Haematology data

Endoscopy data

PAS data

Pathology data

Hampshire Health Record data

Acknowledgments:

POLeMMICColin NewellMagdy El-GohariEmily StimpsonJo DashTina ReinsonJackie HollisLucy GrunerMaria BaggotNatalie StantonWendy O’BrienAndrea JarmanMike MoorePaul RoderickJulia SinclairMiranda KimMaheswaran NaranjanTopher Woelk

Data:HHRIGGNHS SCW CSU

Funding:

British Liver TrustNIHR BRC