Hepatology · London
A hepatology-led fatty liver service in London, for MASLD and MASH.
A named consultant hepatologist, FibroScan and ELF on the first visit, dietetics and diabetes care in the same building - all under NICE NG49 and BSG guidance.
Indicative pricing
What a private fatty liver assessment costs in London.
Indicative ranges across our partner hepatology clinics.
In short
£470–£850, stratified the same visit.
| Service element | Indicative range | Typical duration | Turnaround |
|---|---|---|---|
| Hepatology consultation (new patient) | £250–£450 | 45 min | Same visit |
| FibroScan (VCTE with CAP) | £220–£400 | 15 min | Immediate |
| ELF blood test (Enhanced Liver Fibrosis) | £180–£280 | 10 min bloods | 3–5 days |
| Full MASLD blood panel | £280–£450 | 15 min | 3–7 days |
| Dietitian-led consultation | £140–£240 | 45 min | Same visit |
| MRI-elastography (tertiary centres) | £950–£1,500 | 45 min | 3–5 days |
| Liver biopsy (day-case, indeterminate cases) | £2,200–£3,800 | Half-day | 7–14 days |
| Annual multidisciplinary review | £450–£750 | 60 min | Same visit |
Prices vary by hospital, by consultant and by which tests you actually need - many patients need only a consultation and FibroScan, not the full workup.
The problem
The UK’s commonest liver disease, and its most under-staged.
MASLD (formerly NAFLD) affects around one in four UK adults. Most people are told they have a “bit of fatty liver” and sent home without staging - which misses the small share who already have advanced fibrosis and need treatment now.
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Told it is “nothing”?
A normal ALT does not exclude MASH. FIB-4 and FibroScan reveal what the ALT hides.
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Type 2 diabetes?
Diabetes and MASLD share drivers - staging changes both liver and cardiovascular risk.
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On a GLP-1 already?
Semaglutide and tirzepatide help - a hepatology view helps you use them well.
When it helps
When the fatty liver service is the right step.
The situations we see most, plus the one red flag that means an emergency rather than an appointment.
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Incidental fatty liver on ultrasound
A scan for something else flagged steatosis - usually asymptomatic but worth staging properly.
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Raised ALT or GGT
A persistently abnormal LFT with metabolic risk factors - the commonest referral into the service.
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Type 2 diabetes with metabolic syndrome
Diabetes and MASLD share drivers - proactive staging changes both cardiovascular and liver risk.
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BMI ≥30 with metabolic syndrome
Central obesity, hypertension, dyslipidaemia - the classic MASLD cluster needing structured review.
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Family history of cirrhosis or HCC
A first-degree relative with unexplained liver disease raises the stakes on your own staging.
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Considering a GLP-1 receptor agonist
Semaglutide or tirzepatide with MASLD in the picture - a hepatology view helps you use them well.
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Alcohol plus metabolic drivers (MetALD)
Where alcohol and metabolic factors overlap - the 2023 nomenclature acknowledges it explicitly.
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Red flag: jaundice, ascites, GI bleed
Yellow eyes, a swollen abdomen or vomiting blood are decompensation - same-day A&E, not a clinic booking.
Service pillars
The tests and pillars that make up the service.
What each element actually involves - and where it sits in the NICE NG49 stratification.
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FIB-4 first-line stratification
Age, AST, ALT and platelets - a free calculator that separates most people into low-risk (<1.30) or needs-more-work (≥1.30).
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FibroScan (VCTE) with CAP
Vibration-controlled transient elastography - kPa for fibrosis (F0–F4) and CAP for steatosis. UK first-line imaging under NICE NG49.
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ELF (Enhanced Liver Fibrosis) panel
A serum test endorsed by NICE NG49 for intermediate FIB-4 cases - a score of ≥9.8 suggests advanced fibrosis.
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Full metabolic and liver panel
LFTs, lipids, HbA1c, ferritin, coeliac, hepatitis B/C, autoimmune screen, TSH, alpha-1 antitrypsin, caeruloplasmin, immunoglobulins.
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MR-elastography
Highest-accuracy non-invasive staging - reserved for tertiary centres and cases where VCTE is unreliable (obesity, ascites).
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Liver biopsy (percutaneous or TJ)
Day-case, image-guided - only when non-invasive tests are indeterminate, or to confirm MASH before drug therapy.
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Dietitian-led lifestyle programme
Mediterranean pattern, low-calorie or TRE, weekly weigh-ins, and referral to VLED where the target is ≥10% loss.
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Annual multidisciplinary review
Hepatology, dietetics, endocrinology and cardiology together - the model NICE and BSG recommend for advanced fibrosis.
Safety and treatment
What actually changes the picture - honestly.
MASLD is a slow disease with a fast metabolic backdrop. Most of the wins come from weight loss, cardiovascular optimisation and staging - the drugs are the smaller share.
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MASLD replaces NAFLD (2023)
Metabolic dysfunction-Associated Steatotic Liver Disease is the correct current term. MASH replaces NASH for the inflammatory subtype; MetALD covers dual metabolic and alcohol aetiology.
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Normal ALT does not exclude MASH
Around 30% of people with biopsy-proven MASH have a normal ALT. Staging depends on non-invasive scores and FibroScan, not the ALT alone.
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Weight loss is the single biggest lever
A sustained ≥7–10% body-weight reduction reverses steatosis and drives fibrosis regression - no drug matches it for early disease.
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Exercise helps even without weight loss
150–300 minutes a week of moderate activity plus resistance training improves liver fat and insulin sensitivity independently.
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Cardiovascular risk is the main killer
People with MASLD die of heart disease more often than liver disease. Statins are safe and NICE-approved; BP target <130/80, HbA1c <53 mmol/mol.
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Alcohol is dose-dependent, additive
Even modest alcohol adds to metabolic injury. In MetALD, cutting alcohol changes the trajectory as much as weight loss does.
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Coffee 2–3 cups a day
Observational data links regular coffee to reduced fibrosis. A weak recommendation, but a rare one where habit and evidence align.
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Drug options in 2026
Resmetirom (rezdiffra) - first FDA-approved MASH drug, NICE TA1002 review pending; GLP-1 RA on-label for T2DM and obesity; vitamin E and pioglitazone in selected biopsy-proven MASH.
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Red flags
Jaundice, new confusion, ascites, or vomiting blood are signs of decompensation - call 999 or attend A&E the same day.
Reading your hepatology letter
Your clinic letter in four parts. Read the last one first.
Whichever consultant you see, the letter that lands afterwards keeps to the same shape.
A quiet reminder
Hepatology language is precise and can read coldly - we translate it for you.
If you would like us to talk you through the letter before your review, just ask.
- 01 Header
Diagnosis, stage and aetiology
Whether the picture is MASLD, MASH or MetALD, and the fibrosis stage (F0–F4) integrated across FIB-4, ELF and FibroScan.
- 02 Metabolic
Metabolic and cardiovascular profile
Diabetes status, lipids, blood pressure, BMI and 10-year CV risk - the numbers that most change your prognosis.
- 03 Plan
Lifestyle, pharmacology and surveillance
Weight-loss target, exercise, alcohol, coffee, any drug therapy (GLP-1 RA, resmetirom, statin), and whether HCC surveillance is due.
- 04 Impression
Follow-up cadence and escalation
Read this first: when your next FibroScan is due, when bariatric surgery is on the table, and what would trigger a transplant referral.
Recognised by major UK insurers
Cover for hepatology consultations and FibroScan varies by insurer - usually funded when medically indicated by raised LFTs, incidental findings or metabolic risk.
Frequently asked
Everything we get asked about MASLD and MASH.
Quick answers on terminology, staging, weight-loss targets and the newer drugs.
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What is MASLD and how is it different from NAFLD?
MASLD (Metabolic dysfunction-Associated Steatotic Liver Disease) is the 2023 international rename of NAFLD. The change makes the metabolic driver explicit and adds MetALD for people with both metabolic and alcohol aetiology. MASH replaces NASH for the inflammatory subtype. The British Society of Gastroenterology has adopted the new terminology.
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Do I need a liver biopsy?
Usually not. Most people are staged with a FIB-4 score, an ELF blood test and a FibroScan. Biopsy is reserved for indeterminate results, unusual features, or where a drug like resmetirom needs biopsy-confirmed MASH to be prescribed.
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How much does the fatty liver service cost privately?
A consultant hepatology first visit is roughly £250–£450, a FibroScan £220–£400, the ELF panel £180–£280, and a full MASLD blood panel £280–£450. Bundled first-visit packages are common.
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How much weight do I need to lose?
A sustained loss of 7–10% of body weight is the single most effective intervention - enough to reverse steatosis in most people and to drive fibrosis regression in many. Losses of 3–5% still improve liver fat but do less for inflammation and fibrosis.
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Are GLP-1 drugs like semaglutide safe with a fatty liver?
Yes - and the RCT evidence for MASH resolution is strong. Semaglutide and tirzepatide are on-label in the UK for type 2 diabetes and obesity (per NICE technology appraisals), and are frequently used in MASLD where those criteria are met. Their use purely for MASLD without those indications remains off-label.
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What about resmetirom (rezdiffra)?
Resmetirom is the first drug specifically approved for MASH (US FDA, 2024). NICE technology appraisal TA1002 is under review; UK access outside a private pathway is limited pending the final guidance. It is used in biopsy-proven MASH with significant fibrosis.
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Can I drink alcohol if I have MASLD?
The safest answer is no, and this is more true the more advanced your fibrosis. Alcohol is dose-dependent and additive to metabolic injury. Where alcohol is a genuine contributor, the picture is now formally called MetALD and reducing alcohol changes the trajectory as much as weight loss.
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Do I need cancer surveillance?
If your fibrosis stage is advanced (F3–F4 or cirrhosis), yes - six-monthly liver ultrasound with or without alpha-fetoprotein for hepatocellular carcinoma surveillance. Endoscopic screening for varices and vaccination against hepatitis A and B, pneumococcus, flu and COVID are also part of the pathway.
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