Published: 11 August 2022
With the dramatic rise in liver disease - compounded by multicausality, associated multimorbidities and health inequalities - NIHR liver disease experts Lynsey Corless, William Rosenberg and Karina Mahiouz are calling for new research collaborations and ways of working to improve identification and management of this preventable disease.
Chronic liver disease (CLD) mortality has risen by over 400% in four decades. It’s the third leading cause of premature death in people of working age - with over 40 people a day dying of liver disease in the UK. This trend is sharply at odds with the reduction seen in areas such as cancer and cardiovascular disease.
Most CLD is preventable, yet it is frequently diagnosed late when people are experiencing multiple complications related to their disease and reduced quality of life. Management of these conditions places an increasingly heavy burden on liver services and the wider healthcare system. It is critical that action is taken to address this.
Multi-causality, multimorbidity and health inequalities
In many people, CLD develops and progresses as a result of several factors - most notably alcohol and obesity. The negative effects are compounded by wider determinants of health - including deprivation, smoking and poor nutrition - which are disproportionately observed in patients with CLD and contribute to many other diseases. As such, most people with CLD also experience multimorbidity - the convergence of multiple pathologies in one person - with increased rates of diabetes, cardiovascular disease, and risks of all cancers observed.
Addressing the rising tide of CLD demands research to better understand the interplay and effects of multi-causality and multimorbidity in the development and progression of CLD. Success will lead to earlier identification of people at risk - providing the opportunity to offer effective interventions at a stage when CLD is preventable and where multimorbidity could be minimised.
Any effective approach to research must acknowledge that CLD and multimorbidity disproportionately affect people experiencing deprivation. These same communities also experience health inequality and are under-served in terms of opportunities to take part in research. Delivering more studies in areas of high deprivation and disease prevalence is critical to improving outcomes and is a priority for the NIHR.
Multidisciplinary collaborations and partnerships
Addressing the diagnosis, treatment and prevention of alcohol and obesity-related CLD and multimorbidity in this context requires collaboration between researchers from diverse fields, including hepatology, gastroenterology, behavioural science, primary care, mental health, nutrition, diabetes, cardiology and oncology.
To this end, the NIHR launched a cross-specialty, multidisciplinary project - led by our Hepatology National Specialty Group - to build consensus on the optimal approach to CLD research. Working groups were convened across four areas: Early detection of multimorbidity/liver disease; Behavioural interventions for alcohol and obesity; Pharmacological interventions for CLD and associated conditions; and Physical interventions for CLD and associated conditions. These groups are undertaking reviews of the existing literature and developing high quality, collaborative research proposals - to identify key unanswered questions in each area.
New NIHR liver disease research funding call
The hepatology community’s ambition to deliver cross-specialty, multi-disciplinary research has taken a step forward through a new NIHR funding call (closing on 14 September).
The call is commissioning a range of projects in size and scope to support the establishment and growth of enduring partnerships, networks and collaborations in liver disease research. It presents a major opportunity to reshape and revitalise the UK’s liver research landscape by attracting participants from a diverse range of locations and expertise.
Partnerships will be required to actively include areas and communities previously under-served by research and where clinical need is greatest.
Finally, to ensure funded studies reach those most likely to benefit, there is a need for participant recruitment to be community-based, as well as from secondary care. This will require careful delivery planning from study design onwards - and rely upon a diverse, appropriately trained cross-disciplinary workforce who are supported to deliver research in their roles. The NIHR Hepatology Specialty Group is working with the Clinical Research Network and partners to address these challenges, so that studies have the best chance of success.
The development and delivery of high-quality CLD studies across the UK, supported by NIHR initiatives, has the potential to significantly influence NHS liver services and services managing associated comorbidities - in addition to services outside the NHS - ultimately shaping treatment and prevention strategies of the future. The impact of the discoveries we yield will be strengthened by the participation of many diverse and talented researchers and stakeholders.
It is an exciting time to be involved in liver research and we need the collective involvement of researchers and clinicians from all relevant disciplines - including established and emerging researchers - to tackle this colossal burden of disease. Everyone is welcome.
If you have a research proposal and would like to apply for funding, visit our liver disease funding page. Alternatively, to get involved in our cross-disciplinary work to improve research into the diagnosis, treatment and prevention of liver disease - contact the NIHR Hepatology National Specialty Group.
- Dr Lynsey Corless is the National Specialty Lead for Hepatology at NIHR Clinical Research Network at the NIHR Clinical Research Network, and a Consultant Hepatologist at Hull University Teaching Hospitals.
- Professor William Rosenberg is the Deputy Medical Director at the NIHR Clinical Research Network. He holds the Peter Scheuer Chair of Liver Diseases at the Institute for Liver and Digestive Health, University College London.
- Karina Mahiouz is the NIHR Clinical Research Network (CRN) Specialty Cluster Manager (Cluster A) - responsible for the CRN Hepatology Specialty.