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Guidelines on the management of abnormal liver blood tests

Abstract

These updated guidelines on the management of abnormal liver blood tests have been commissioned by the Clinical Services and Standards Committee (CSSC) of the British Society of Gastroenterology (BSG) under the auspices of the liver section of the BSG. The original guidelines, which this document supersedes, were written in 2000 and have undergone extensive revision by members of the Guidelines Development Group (GDG). The GDG comprises representatives from patient/carer groups (British Liver Trust, Liver4life, PBC Foundation and PSC Support), elected members of the BSG liver section (including representatives from Scotland and Wales), British Association for the Study of the Liver (BASL), Specialist Advisory Committee in Clinical Biochemistry/Royal College of Pathology and Association for Clinical Biochemistry, British Society of Paediatric Gastroenterology, Hepatology and Nutrition (BSPGHAN), Public Health England (implementation and screening), Royal College of General Practice, British Society of Gastrointestinal and Abdominal Radiologists (BSGAR) and Society of Acute Medicine. The quality of evidence and grading of recommendations was appraised using the AGREE II tool. These guidelines deal specifically with the management of abnormal liver blood tests in children and adults in both primary and secondary care under the following subheadings: (1) What constitutes an abnormal liver blood test? (2) What constitutes a standard liver blood test panel? (3) When should liver blood tests be checked? (4) Does the extent and duration of abnormal liver blood tests determine subsequent investigation? (5) Response to abnormal liver blood tests. They are not designed to deal with the management of the underlying liver disease.

  • fibrosis
  • liver
  • nonalcoholic steatohepatitis
  • alcoholic liver disease

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Footnotes

  • Contributors PNN: consultant hepatologist, University of Birmingham/University Hospitals Birmingham; chair of BSG liver section; chair of Guideline Development Group and lead author. RC: consultant chemical pathologist, University Hospitals Birmingham; co-author of sections ‘What constitutes an abnormal liver blood test? and Does the extent and duration of abnormal liver blood tests determine subsequent investigation?’; review of entire guideline. SD: consultant paediatric hepatologist and British Society of Paediatric Gastroenterology, Hepatology and Nutrition representative, Leeds Children’s Hospital, Leeds General infirmary; co-author of sections on paediatric hepatology; Review of entire guideline. JD: consultant hepatologist, University of Dundee/Ninewells Hospital, Dundee; co-author of section ‘Does the extent and duration of abnormal liver blood tests determine subsequent investigation?`; review of entire guideline. MF/KS: general practioners, co-authors of section ‘When should liver blood tests be checked’; Review of entire guideline. EMG: consultant radiologist, Cambridge University Hospitals; co-author of section related to imaging; review of entire guideline. UH/AM/JV: public health England; co-authors of sections related to case-finding; review of entire guideline. RH/AL/RM-T/MW: patient/carer representatives; co-authors of section ‘What constitutes an abnormal liver blood test?’, ‘Response to abnormal liver blood tests’; review of entire guideline. MH: BASL/BSG representative; co-author of section ‘Response to abnormal liver blood tests’; review of entire guideline. CR: Society of Acute Medicine representative; review of entire guideline. NCS: BSG representative; co-author of following sections: introduction, when tests checked and alcohol; review of entire guideline. AY: BSG representative; co-author of section ‘What constitutes an abnormal liver blood test?’; review of entire guideline.

  • Funding This work was funded by support from the British Society of Gastroenterology. PNN is supported by the National Institute of Health Research (NIHR) Birmingham Biomedical Research Centre. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.

  • Competing interests PNN: chief investigator for Echosens diagnostic study.

  • Provenance and peer review Commissioned; externally peer reviewed.

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