ArticleFrontline gastroenterology2020
The Development and Implementation of a Commissioned Pathway for the Identification and Stratification of Liver Disease in the Community.
Article in Frontline gastroenterology, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 39 papers, 1 of them a synthesis that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
39 citing papers in PubMed, 1 synthesis or guideline pooled it, 68 citations in OpenAlex.
- Comparison of models to predict incident chronic liver disease: a systematic review and external validation in Chinese adults.BMC medicine · 2024Pooled it
- Targeted community screening in areas of high socioeconomic deprivation enhances the detection of liver fibrosis.Hepatology communications · 2026Article
- Large Language Models for Diagnosis and Prognosis of Chronic Liver Diseases: A Systematic Review.Health science reports · 2026Review
- A liver function test pathway significantly increases the early detection of chronic liver disease and cirrhosis.Hepatology communications · 2026Article
- Reducing alcohol-associated liver disease burden in the general population.The lancet. Gastroenterology & hepatology · 2025Review
- Call to action: integrating steatotic liver disease into public health strategies in Canada.Lancet regional health. Americas · 2025Review
- Barriers and facilitators to liver fibrosis screening: Perspectives and practices of Canadian primary care physicians.Canadian liver journal · 2025Article
- Evaluating the Diagnostic Potential of the FIB-4 Index for Cystic Fibrosis-Associated Liver Disease in Adults: A Comparison with Transient Elastography.Journal of clinical medicine · 2025Article
- Screening high-risk Veterans for cirrhosis: taking a stepwise population health approach.BMC health services research · 2025Article
- Correspondence to editorial on "Prevalence of clinically significant liver fibrosis in the general population: A systematic review and meta-analysis".Clinical and molecular hepatology · 2025Article
- Detection of early-stage hepatocellular carcinoma: a retrospective evaluation of ultrasonography surveillance and surveillance adherence.Translational gastroenterology and hepatology · 2025Article
- Interpreting elevated liver blood test results through a genetic lens: A genome-wide association study.Liver international : official journal of the International Association for the Study of the Liver · 2024Article
- Screening for liver fibrosis: lessons from colorectal and lung cancer screening.Nature reviews. Gastroenterology & hepatology · 2024Review
- Screening patients in general practice for advanced chronic liver disease using an innovative IT solution: The Liver Toolkit.Hepatology communications · 2024Article
- FIB-4 and APRI for cirrhosis detection in a privately insured national cohort.JHEP reports : innovation in hepatology · 2024Article
- Role of fatty liver index in risk-stratifying comorbid disease outcomes in non-alcoholic fatty liver disease.JHEP reports : innovation in hepatology · 2023Article
- Quality standards for the management of alcohol-related liver disease: consensus recommendations from the British Association for the Study of the Liver and British Society of Gastroenterology ARLD special interest group.BMJ open gastroenterology · 2023Article
- Does knowledge of liver fibrosis affect high-risk drinking behaviour (KLIFAD): an open-label pragmatic feasibility randomised controlled trial.EClinicalMedicine · 2023Article
- Stratification Of LIver Disease (SOLID): protocol for a prospective observational cohort study to determine the optimum biomarker strategies for the detection of advanced liver disease at the primary-secondary care interface.BMJ open gastroenterology · 2023Article
- #FGDebate: Should we focus on detecting patients at risk of liver disease in the community?Frontline gastroenterology · 2023Article
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Authors and funding
10 authors at 2 institutions in 1 country.
Funding
Abstract
objectiveTo describe the development of the Nottingham liver disease stratification pathway, present a 12-month evaluation of uptake, stratification results and compare the pathway to current British Society of Gastroenterology (BSG) guidelines.
designA referral pathway between primary and secondary care for the detection and risk stratification of liver disease.
settingFour Nottinghamshire Clinical Commissioning Groups (700,000 population). PATIENTS: Patients are referred to the pathway with i) raised AST/ALT ratio ii) harmful alcohol use or iii) risk or presence of non-alcoholic fatty liver disease (NAFLD).
interventionsClinic attendance within secondary care for transient elastography (TE) and brief lifestyle intervention. The TE result is reported back to the GP with advice on interpretation and referral guidance.
main outcome measuresPathway uptake, patient characteristics, liver disease stratification results and stakeholder feedback.
resultsOver the first 12 months 968 patients attended a TE clinic appointment, with raised AST/ALT ratio being the most common single reason for referral (36.9%). Of the total, 222 (22.9%) patients had an elevated liver stiffness (≥8kPa) and in 60 (27.0%) liver stiffness was indicative of advanced chronic liver disease. If a traditional approach based on raised liver enzymes (BSG guidance) had been followed, 38.7% of those with significant liver disease (≥8kPa) would have gone undetected among those referred for either NAFLD or raised AST:ALT.
conclusionsTargeting patients with risk factors for chronic liver disease and stratifying them using TE can detect significant chronic liver disease above and beyond the approach based on liver enzyme elevation.
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.