In 2014, Practical Gastroenterology first introduced a series of review articles with the goal of providing a detailed review of many aspects of the management of liver and biliary diseases, intended for professionals to use as reference points in their clinical practices. Today, we re-introduce a new series of liver-related articles, to continue and expand upon this purpose.
Fostering a foundation of knowledge related to liver disease management remains a highly relevant practice for all clinicians. The CDC estimates that 4.5 million adults in the United States, nearly 2% of the population, carry a diagnosis of liver disease, which is responsible for over 44,000 deaths per year.1 The economic burden of chronic liver disease to the United States remains substantial. Considering just inpatient costs, the national hospitalization costs in patients with chronic liver disease exceeds $81 billion, while, on the ambulatory side, in considering only nonalcoholic fatty liver disease, or NAFLD, which affects roughly 100 million Americans, costs accrued by the United States healthcare system in 2018 reached $32 billion annually.2,3 While liver diseases such as chronic hepatitis B and C and hemochromatosis are now relatively easy to control and prevent progression, or cure, current management options for alcohol use disorder and NAFLD remain suboptimal, despite the high prevalence of these diseases. Consequently, the prevalence of advanced liver disease and cirrhosis remains high, with over 600,000 patients estimated to have cirrhosis in the United States.4 For many patients with decompensated cirrhosis, liver transplantation remains the only option to significantly improve mortality. The total cost billed for a liver transplant from 30 days prior to transplant to 6 months after transplant was estimated to average $577,000.5
For a practicing clinician, having a solid understanding of the diagnosis and management of liver-related conditions is essential to optimizing the care and prognoses of their patients. In most cases, early diagnosis is optimal. The goal of this series is to provide timely and relevant reviews on a variety of liver diseases, highlighting the most recent advances and management strategies published in the medical literature. We aim to provide information, and will focus our selections of topics, so as to be relevant to general gastroenterologists and primary care providers, who are on the front lines of patient care. Our first review, appearing in this issue, will detail the diagnosis and management of autoimmune liver disease variants. Future articles in this series will address topics including acute liver failure, hepatic encephalopathy, drug-induced liver injury, intrahepatic cholestasis, dietary approaches to the management of NAFLD, evaluation of solid liver lesions, and a review of newer concepts in pre- and post-liver transplant care directed towards the primary care provider.
- Summary Health Statistics Tables for U.S. Adults: National Health Interview Survey, 2018, Table A-4b, A-4c.
- JAMA Netw Open. 2020;3(4):e201997. doi:10.100 /jamanetworkopen.2020.1997
- Intermountain Medical Center. “Economic burden of fatty liver disease in US is $32 billion annually, new study finds.” ScienceDaily. www.sciencedaily.com/ releases/2018/07/180703105956.htm
- Journal of Clinical Gastroenterology: September 2015 – Volume 49 – Issue 8 – p