A review in Gastroenterology updates the global picture of liver disease. Chronic liver disease affects more than 1.5 billion people. Cirrhosis is the 12th leading cause of death worldwide and, with primary liver cancer, accounts for nearly 2.4 million deaths a year, disproportionately in low- and middle-income countries.
The main drivers are alcohol-associated liver disease, metabolic dysfunction-associated steatotic liver disease and viral hepatitis. The authors expect the first two to grow with demographic change, rising obesity and alcohol consumption, while vaccination and antiviral therapy continue to reshape viral hepatitis. Complications such as decompensation, acute-on-chronic liver failure and liver cancer are linked to limited access to advanced therapies in resource-restricted regions. Africa has the highest age-standardised mortality from cirrhosis and liver cancer, driven by viral hepatitis, aflatoxin exposure and limited access to care.
It is a narrative review, not new data. For India, where all three drivers are prominent, it supports integrated early detection and equitable access to care, and it is context rather than a change in what to do in clinic.
- Ask about alcohol and metabolic risk factors together, since they now interact
- Test for hepatitis B and C in anyone with raised liver enzymes or risk factors
- Offer hepatitis B vaccination to non-immune patients with chronic liver disease
- Assess fibrosis stage non-invasively in patients with fatty liver and metabolic risk
- Link people with cirrhosis to surveillance and specialist care early
Why it matters
The review frames liver disease as the sum of alcohol, metabolic and viral causes, which rarely occur alone in practice.
Don't overread it
This is a narrative review of the global picture; it does not address any individual patient's risk or change a guideline.
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