Cirrhosis and end-stage chronic liver disease: The changing scenes on etiopathogenesis

• Published in: Current medicine research and practice 2014-03, Vol.4 (2), p.62-77
• Main Author: Nayak, Nabeen C.
• Format: Article
• Language: English
• Subjects: Cirrhosis; Etiologic factors; Hepatocellular carcinoma; Prevalence scenario; Time trend
• ISSN: 2352-0817; 2352-0825
• DOI: 10.1016/j.cmrp.2014.03.003

Liver cirrhosis and its most serious complication hepatocellular carcinoma (HCC) together make up for a substantial proportion of human diseases carrying high morbidity and mortality. Years of sustained research efforts involving clinical, epidemiological and laboratory studies have succeeded in sequential unraveling of the etiological factors for the vast majority of these two diseases. Unfolding the scenarios on these through time will help to understand and logically analyze the current situation on cirrhosis and HCC and to plan effective control and management strategies on them in the coming years. Even though Laennec who first gave the name cirrhosis had noted its occurrence in alcoholics, for more than a century the disease seen all around the world was considered to be caused by nutritional deficiency. In the Asian and African countries many of these livers had hepatocellular carcinoma (HCC), a rapidly fatal tumor. In the 1950s it was confirmed that alcohol directly injures the liver and prolonged alcohol abuse leads to cirrhosis. By the end of twentieth century three other major etiologic factors for cirrhosis were identified, hepatitis B virus (HBV), hepatitis C virus (HCV) and nonalcoholic fatty liver disease (NAFLD). HBV and HCV were also found to be carcinogenic to the liver and causally related to the vast majority of HCC. HBV was considered to bear the largest share in causing the global burden of cirrhosis and HCC and the most dominant of the four major causes in Asian and African countries. Preventive measure for the parenterally transmitted HBV and HCV infections were implemented and a highly effective HBV vaccine was administered universally to newborns and children in some countries. Presently, the etiologic factors for more than 90% cases of cirrhosis and HCC, their sources and ways of controlling exposure to them are known. In all parts of the world these diseases caused by HBV are on the decline to variable extents, resulting largely from the wide use of control measures including the universal vaccination programs, the latter to a limited degree. Cirrhosis and HCC caused by HCV and NAFLD which is associated with metabolic syndrome are steadily increasing while the ones related to alcohol abuse have remained steady at earlier levels or are mildly increasing in developed countries but progressively increasing in the developing countries. Increasing use of adequately effective anti-viral medications for HBV and HCV infection and wider