Liver fibrosis due to alcohol - British Liver Trust

British Liver Trust
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Liver fibrosis due to alcohol

kippy2
kippy2

June 2019 i had an enhanced liver function blood test. Results were I have been diagnosed with fatty liver and Liver Fibrosis, my score was 9. I have worked so hard on trying to get better. I have drank 98 units of alcohol in a year, previously I would have drank that amount in two weeks. But since June last year I eat a lot of chocolate, but otherwise eat very healthily and I often walk miles. It’s been a year since the first ELF blood test and being optimistic I thought my liver condition would have improved greatly. So I had another ELF blood test and to my horror and disappointment my fibrosis level has increased to 9.8 I cannot understand why! Can anybody shed some light on this. Any help is appreciated. I’m in bits and now don’t know how to improve the situation. My score is .2 off of becoming severe!

25 Replies
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Hi kippy, it might be that you have a combination of fatty liver disease both alcohol and non-alcohol related. Whilst you have obviously taken some steps to improve your health there might be more you can do. It would be wise to go full on zero alcohol because every mouthful of that stuff is poison to your liver, it's already showing you that it has sustained damage and giving it more to struggle with - even at a vastly reduced amount - can cause further harm.

Have a look at the BLT page on NAFLD and alcohol and the liver.

britishlivertrust.org.uk/in...

britishlivertrust.org.uk/in...

It's also possible you have something other than fatty liver causing your issues, if you do continue to see worsening then that might need to be investigated.

Katie

kippy2
kippy2 in reply to AyrshireK

Thank you for your reply. The doctor said my enzymes are ok, so I presume that means the liver is functioning as it should. It seems that the increased fibrosis figure has gone up dramatically in the last year. Is it wise to ask for an MRI?

Xx

AyrshireK
AyrshireK in reply to kippy2

My hubby has cirrhosis and in 8 years of diagnosis has only had an MRI once due to changes (lesions) in his liver. Not sure what an MRI would reveal in your case.

kippy2
kippy2 in reply to AyrshireK

Ok, I will have to speak to doctor, but cant get app. until 29th

I feel for you and your husband, and wish you well.

I honestly haven’t a clue if this matters but Chocolate has huge amounts of fat in it. (Galaxy milk is my favourite) When I was diagnosed the dietician said I shouldn’t eat chocolate at all but she consented to 1 small square of dark chocolate twice a week. I dislike dark chocolate anyway 😏so that was rubbish.

There are definitely changes in my bloods (I can’t say exactly what because I don’t understand it enough) I just know because I have my bloods done once a month so I know what I have eaten in comparison to my bloods and my doc goes through the talk with me 🥴.

kippy2
kippy2 in reply to jazzjam

Thank you for your reply,. I don’t like dark chocolate either. Do you have liver fibrosis. If so was it caused by alcohol or diet?

I can’t see my GP doing blood tests every month :-( Do you regularly have scans? I shall ask my doctor for one as it’s been a year.

I’m struggling to know what I can and can’t eat snd drink!

jazzjam
jazzjam in reply to kippy2

I have cirrhosis now. I was advised to eat low sugars, low fats, high protein and to eat small and often. Definitely no alcohol and very low salt but this was for my diagnosis. Certainly the liver does not like high fats, high sugars and salt so basically a healthy eating plan. To keep in mind things like tinned tomatoes, stock, dressing. Everything you buy ready off the shelf basically. So I now cook everything from scratch. I am sure whatever the diagnosis you can only help the liver by eating a healthy plan, something similar to the Mediterranean diet is a good one. I really struggled also knowing what to eat and some days even now I get fed up thinking what can I have today that doesn’t take a lot of time and is tasty. I did see a dietician eight at the very start and she was very good and got me on the right path, quite basic and boring but it really helped.

I have a scan once a year, although I did have 2 last year.

kippy2
kippy2 in reply to jazzjam

Thank you jazzjam for the info.

We had a bbq today. I had chicken and salad but I did put some dressing on it, that’s a no no now then.

HiddenThis reply has been deleted
AyrshireK
AyrshireK in reply to Hidden

No, Kippy is referring to the score obtained from a ELF Test (Enhanced Liver Fibrosis Test) which is a set of blood tests from which an algorithm calculates the level of fibrosis.

What is the ELF Blood Test?

ELF stands for Enhanced Liver Fibrosis. The ELF Blood Test combines three serum biomarkers, which have been shown to correlate to the level of liver fibrosis assessed by liver biopsy. These biomarkers include:

Hyaluronic acid (HA)

Procollagen III amino terminal peptide (PIIINP)

Tissue inhibitor of metalloproteinase 1 (TIMP-1)

static.healthcare.siemens.c...

static.healthcare.siemens.c...

Thank you for the explanation. I have been told the only trustworthy test for the liver is a Fibroscan or biopsy. Blood tests can often be inaccurate. Is that the belief in the UK?

The ELF test is deemed so accurate it is now recognised by the National Institute for Health & Care Excellence. The NICE provides evidence-based guidelines across healthcare and is used by local authorities to inform healthcare-related decisions. NICE has recently recommended the use of the ELF test to test for and monitor advanced liver fibrosis in people diagnosed with Non Alcoholic Fatty Liver Disease (NAFLD).

Earlier Liver Function Tests were deemed not so accurate as even people with advanced liver disease can return near if not normal LFT's. LFT's alone are not sufficient for monitoring or diagnosing liver issues.

Even fibroscan and biopsy have their issues as regards accuracy - Fibroscan can not differentiate between fibrous tissue and ongoing inflammation so people often get told they have a higher degree of damage than they actually have IF they have inflammation. There have been members on here who got a full on 75 kPa score which all the charts read as full on cirrhosis and yet they had liver inflammation and little to no fibrosis at all.

Biopsy is only useful when they get a sufficient sample and from the correct bit of liver. Both of my husbands biopsies (one conventional and one transjugular both failed to identify why he had liver damage, they confirmed cirrhosis but not the cause).

A perfect diagnosis and monitoring scenario requires a jigsaw of all various types of tests put together to form the full picture.

Katie

HiddenThis reply has been deleted
AyrshireK
AyrshireK in reply to Hidden

British Liver Trust has a page/pages dedicated to liver tests. britishlivertrust.org.uk/in...

Katie

Hi kippy2,

Have you had any other tests to confirm fatty liver and fibrosis, like ultrasound and fibroscan? The reason I ask is that although the ELF test is good at predicting fibrosis stages in already clinically proven cases of fibrosis (usually biopsy proven), it is not recommended for initial diagnosis or screening for undiagnosed liver disease (even by it's producers Siemens), this is because in previous studies, ELF tests on healthy subjects with proven healthy livers (i.e no liver disease) have shown scores as high as in the 10s, therefore it would be unwise to use as a diagnostic tool as this could cause great distress to someone who has a high score but no fibrosis. Also the test is influenced by other factors such as age, sex (males read higher than females), ongoing inflammation or fatty infiltration, time of day sample was taken and other fibrotic diseases like cystic fibrosis, heart disease, various forms of arthritis etc (so it is not always organ specific). This was confirmed to me by my own research and situation. I had an ELF test done after a being a long time heavy drinker and like yours it was 9, now this freaked me out and would have had me convinced I had moderate to severe fibrosis. The thing that niggles me was that over the past 10 years I have had around 5 or 6 fibroscans done at different times and locations and none were ever over 5 Kpa and I was always told I had no fibrosis, so a 9 ELF score worried me especially because it was only about 3 weeks after a fibroscan which was 4.6 Kpa. So I paid to see a Consultant Hepatologist, and he told me ELF was not a good enough diagnostic tool for screening for fibrosis (I live in Belfast and ELF is not used in Northern Ireland for screening, I got mine privately) and that he would always rely on fibroscan and imaging over blood tests as they are organ specific. He sent me for an ultrasound and together with my fibroscan scores was happy that I had little to no fibrosis.

Sorry for the long post but if you haven't already, ask for other imaging tests to verify the health of your liver. Multiple diagnostic tests are always better than any singular test and imaging seems to be more specific and reliable than blood tests. There have been other members here have had variations in ELF tests and imaging, I figure if two tests are at odds it is definitely worth investigating it more and getting to the bottom of things.

Sorry for the long and winding ramble, hope some of it helps. Take care and all the best 🙂

kippy2
kippy2 in reply to Hanc

Hanc

Very Informative thank you. I had an ultrasound June last year after the results of the ELF blood test. The doctor who did the scan said, ‘yes you have fatty liver’, I asked about the scarring, because the ELF test showed the fibrosis, he said he couldn’t see any scarring but that wasn’t to say there wasn’t any, I was confused then and with thus year’s score of 9.6 I’m still confused and very worried. Do you think I should ask for a fibroscan this time, or MRI or ultrasound?

Hi Kippy2, Both MRI and fibroscan are good, if I were you I would go for fibroscan as most now can give you a CAP score, which lets you know how fatty the liver is, but as Katie said above you have to make sure you have no on going inflammation in the liver as this can skew the fibroscan reading (usually giving a higher reading), so I would ask your G.P to run another LFT blood panel and if the ALT is in normal range, you probably don't have much inflammation and can go ahead and ask for a fibroscan which will hopefully let you know how fatty your liver is and if there is any fibrosis (hopefully not). But I would definitely want the fibroscan, you are well within your rights and fully justified to ask for this to fully get to the bottom of this. You need a full picture of what's going on and the best way is to never rely on one test but a number to give the G.P the full picture, you owe it to yourself to get the best diagnosis possible, even a biopsy on its own can be wrong. Hope this helps I wish you all the best and you have a lot of support on this site 😃

kippy2
kippy2 in reply to Hanc

Great Hanc thanks for your support. Are the ALT the enzymes because if so they are ok.

You have definitely helped me a lot 😊

All the best to you too , take care, stay safe

Hi kippy2, yes the ALT is part of your LFT panel, so if it's normal I would ask your G.P to refer you for a fibroscan to get a better overall picture and it could also give you time to lose some fat from your liver, without the alcohol. Hope all goes well. Take care 🙂

kippy2
kippy2 in reply to Hanc

Hi Hanc

So do you think the blood test fibrosis score went up in a year because of more fat because I was eating a lot of chocolate, and chocolate i e cream, and this in turn has caused more scarring?

In your opinion is one chocolate digestive a day safe now.

Sorry to keep asking you questions but you seem very knowledgeable about the disease.

Thank you

Hi kippy2, diet should definitely help with fatty liver, try cutting out the bad carbs and fats (the Mediterranean diet is great lots of fresh vegetables, fish, chicken etc), also be careful with fruit as there is quite a lot of sugar there. If the fatty liver/fibrosis is caused by alcohol, then it is the main thing to avoid and the liver should heal. Exercise is also great (there's nothing like a brisk walk 🙂). There are plenty of posters on this site very knowledgeable about such things, their posts have helped me a lot. Hope this helps. A chocolate bickey, if you're dieting and exercising shouldn't be too bad, just watch the hidden sugars 😁

kippy2
kippy2 in reply to Hanc

Hi Hanc

Thank you so much for helping me. 😀

Doctor wasn’t any help this morning, and she said it’s unlikely I’ll be given a scan, because of where my liver is at and it’s expensive. What do they wait until someone is quite advanced??? none of it makes sense to me, surely they’d want to nip it in the bud!

Anyway she said, ‘speak to your own doctor next Monday‘.

All the best to you Hanc.

Hi kippy2 with the ELF score and the inconclusiveness of the ultrasound in being able to tell if you have fibrosis I would have thought the G.P would have had no worries in referring you for a fibroscan to get a full picture. I would explain your worries when you see your G.P and push for the fibroscan. Hope this helps 🙂

kippy2
kippy2 in reply to Hanc

Hi Hanc

Thank you for your encouragement, I will tell him it is affecting my mental health, which it is and hopefully he will send me for a fibroscan, let’s hope he doesn’t say, ‘best you go back on the antidepressant meds again’.

Hanc
Hanc in reply to kippy2

Absolutely Kippy2, it's your health and you're well within your rights to get to the bottom of things and if there's any doubts speak to your G.P and explain you want to know so as you can best deal with it properly going forward, your Dr should be happy to do this for your health's sake. Hope it goes well. :-)

kippy2
kippy2 in reply to Hanc

Thanks Hanc. I will press the point. 😊

Hanc
Hanc in reply to kippy2

Good stuff, hope all goes well 🙂

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