Changes in the etiology of liver cirrhosis and the corresponding management strategies

Abstract

We read with interest the article by Xing Wang, which was published in the recent issue of the World Journal of Hepatology 2023; 15: 1294-1306. This article focuses particularly on the prevalence and trends in the etiology of liver cirrhosis (LC), prognosis for patients suffering from cirrhosis-related complications and hepatocellular carcinoma (HCC), and management strategies. The etiology of cirrhosis varies according to geographical, economic, and population factors. Viral hepatitis is the dominant cause in China. Vaccination and effective treatment have reduced the number of people with viral hepatitis, but the overall number is still large. Patients with viral hepatitis who progress over time to LC and HCC remain an important population to manage. The increased incidence of metabolic syndrome and alcohol consumption is likely to lead to a potential exponential increase in metabolic dysfunction-associated steatotic liver disease (MASLD)-associated LC and alcoholic liver disease in the future. Investigating the evolution of the etiology of LC is important for guiding the direction of future research and policy development. These changing trends indicate a need for greater emphasis on tackling obesity and diabetes, and implementing more effective measures to regulate alcohol consumption in order to reduce the occurrence of MASLD. In an effort to help cope with these changing trends, the authors further proposed countermeasures for healthcare authorities doctors, and patients.

Keywords: Liver cirrhosis; Etiology; Viral hepatitis; Alcoholic liver disease; Hepatocellular carcinoma; Metabolic dysfunction-associated steatotic liver disease

Core Tip: China is aiming to eradicate viral hepatitis as a public health threat by 2030. It is expected that the prevalence of viral hepatitis will decrease in the coming years. The increasing prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD) may emerge as a leading cause of liver cirrhosis. Additionally, excessive alcohol consumption is a significant risk factor. These shifting trends necessitate innovative management strategies. There is a need for sustained implementation of measures to eliminate viral hepatitis, as well as greater efforts to control obesity, diabetes and alcohol consumption to reduce the incidence of MASLD and Alcoholic liver disease.