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

Since all four major etiologic factors are from the living human environment, diseases related to them are potentially preventable. If circumstances countering the exposure to and operation of these factors are favorable and an effective HCV vaccine becomes available soon, a likely scenario for prevalence of cirrhosis and HCC around the middle of this century can be visualized. The total global burden of these diseases will come down significantly, most of it involving the developing countries in Asia and Africa mainly because of marked reduction in the HBV related segments. The major share of diseases will be those related to alcohol and NAFLD, the latter dominating the scene in developing countries. HCV related disease will also reduce to reasonable extents, more so in developed countries.