1Institute of Liver Studies, King's College Hospital NHS Foundation Trust, London, UK.
2Department of Gastroenterology and Hepatology, Royal Surrey NHS Foundation Trust, Guildford, UK.
3SAS Trace Element Laboratory, Royal Surrey NHS Foundation Trust, Guildford, UK.
4Berkshire and Surrey Pathology Services, Royal Surrey NHS Foundation Trust, Guildford, UK.
5Department of Biochemistry, Synnovis Analytics, King's College Hospital NHS Foundation Trust, London, UK.
6Department of Clinical and Experimental Medicine, FHMS, University of Surrey, Guildford, UK.
The European Association for the Study of the Liver (EASL) has recently (June 2022) produced new clinical practice guidelines for the investigation and management of haemochromatosis, to replace the previous document published in 2010. Here, we provide an overview of the principal changes recommended for the investigation and management of haemochromatosis arising from these guidelines and highlight particular areas where evidence is lacking and where future focus on specific research would improve patient treatment and outcomes. The guideline provides several important new recommendations that will have a meaningful impact on patient management. Specifically, the use of hepatic elastography as a non-invasive assessment of fibrosis, erythrocytapheresis as an alternative treatment modality to classical phlebotomy, surveillance for hepatocellular carcinoma, dietary recommendations in patients with haemochromatosis and guidance on controversial topics including the management of P.C282Y/p.H63D compound heterozygotes, which have been a source of controversy within the field. It is anticipated that the new guidance will affect the management of haemochromatosis patients commonly seen in gastroenterology, liver and related clinics (e.g. haematology and rheumatology) and with this publication we intend to highlight these changes so as to empower clinicians with the confidence to bring these improvements to their translational practice in the treatment of these patients.