The evidence supports the routine adoption of a change to the Enhanced Liver Fibrosis (ELF) test score cut-off from 10.51 to 9.8 to diagnose advanced fibrosis (AF) in people with metabolic dysfunction-associated steatotic liver disease (MASLD) in any healthcare setting. Evidence for use of a two-step pathway using the Fibrosis-4 (FIB-4) index, followed by an ELF test for people with an indeterminate FIB-4 score in primary care, is promising, but insufficient to support routine adoption. Evidence exists for the diagnostic accuracy of the ELF test at a cut-off of 9.8 to diagnose AF in people with MASLD. Use of a two-step pathway may reduce unnecessary referrals to secondary care. Health economic assessment estimates that reducing the ELF test cut-off from 10.51 to 9.8 is likely to be cost effective, with an incremental cost-effectiveness ratio of £14,842 per quality-adjusted life year gained. Cost effectiveness remained in a scenario reducing the ELF test cut-off in a two-step pathway following an indeterminate FIB-4.
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Guidelines
Liver
British Society of Gastroenterology guidelines for diagnosis and management of autoimmune hepatitis
clinical-resource/Diagnosis-management-of-autoimmune-hepatitis
This guideline was published in October 2024.

Guidance
Clinical Resources Area
British Society of Gastroenterology practice guidance on the management of acute and chronic gastrointestinal symptoms and complications as a result of treatment for cancer
clinical-resource/Acute-chronic-gastrointestinal-symptoms-cancer
Survival rates after a diagnosis of cancer are improving. Poorly managed gastrointestinal (GI) side effects can interfere with delivery of curative cancer treatment. Long-term physical side effects of