What criteria should I use to refer a patient with suspected liver cirrhosis to a hepatologist?

Referral criteria for a patient with suspected liver cirrhosis to a hepatologist:

• Refer all people diagnosed with cirrhosis, including those diagnosed by transient elastography or other imaging, to a hepatologist or gastroenterologist with an interest in hepatology if not already under specialist care.
• If the person has signs of decompensated liver disease (such as ascites, encephalopathy, or gastrointestinal bleeding), arrange emergency hospital admission or immediate referral to a hepatologist or gastroenterologist.
• Refer people who have, or are at high risk of, complications of cirrhosis to a specialist hepatology centre.
• People with alcohol-related liver disease should be considered for referral to specialist alcohol services alongside hepatology referral.
• Early referral to a multidisciplinary palliative care team is recommended for people with end-stage liver disease, including end-stage decompensated cirrhosis, ongoing alcohol use with decompensated alcohol-related liver disease, irreversible decompensated disease unsuitable for liver transplantation, or those with hepatocellular cancer appropriate for best supportive care.
• Adults with chronic hepatitis B who are hepatitis B surface antigen positive should be referred to a hepatologist or gastroenterologist with an interest in hepatology.

Following specialist assessment, some patients may be managed in primary care using a shared-care approach.

Referral should include relevant initial test results to aid specialist assessment.

Urgent referral to specialist nurse-led liver clinics may be appropriate in some cases to avoid admission, depending on local service provision.

These recommendations are based on NICE guidelines on cirrhosis and hepatitis B, and British Society of Gastroenterology best practice guidance.

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