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Chronic liver disease and liver cirrhosis in China : The current situation

Millions of people worldwide suffer from chronic liver disease , which increases the burden of public health resources . In this article , the current diagnosis and treatment of complications of chronic liver disease and liver cirrhosis in China are described .
Li Beiling Hepatology Unit , Department of Infectious Diseases , Nanfang Hospital , Southern Medical University , Guangzhou 510515 , China
Chen Jinjun Hepatology Unit , Department of Infectious Diseases , Nanfang Hospital , Southern Medical University , Guangzhou 510515 , China ; Hepatology Unit , Zengcheng Branch , Nanfang Hospital , Southern Medical University , Guangzhou 510515 , China
Liver disease is common and prevalent in
China , and mainly includes hepatitis B , hepatitis C , alcoholic fatty liver disease , and non-alcoholic fatty liver disease . Data reveal that over one fifth of people suffer from liver disease and viral infection in China , especially from hepatitis B . 1 The burden of viral hepatitis is closely associated with social and economic development , specifically , the burden of viral hepatitis is low in economically developed regions , while the burden is the highest in undeveloped regions . 2 In recent years , the burden of viral hepatitis has been relieved somewhat by the extensive use of antiviral drugs . Additionally , the prevalence of alcoholic liver disease and fatty liver disease increase with improved socio-economic status . A large-scale community investigation showed that the prevalence of non-alcoholic fatty liver disease was 11.5 %– 36.5 % in adults and that it will become the leading cause of end-stage liver disease . 3 The natural history of chronic liver disease includes : hepatitis ; liver cirrhosis ; liver failure ; and hepatocellular cancer .
Infection is a common clinical problem in liver cirrhosis There are complications when hepatitis progresses to liver cirrhosis , such as ascites , oesophageal gastric-fundus variceal bleeding , infection , and hepatic encephalopathy , of which ascites and infection are the most common . Studies have shown the incidence of bacterial infection is about 25 %– 46 % in patients with acute decompensated cirrhosis , and the risk of sepsis in these patients was 2.6-times higher than in patients without liver cirrhosis . 4 , 5
Abdominal infection is the most common infection in patients with liver cirrhosis . Abdominal infection in patients with liver cirrhosis is mainly caused by intestinal bacterial translocation : in the context of portal hypertension and increased permeability of intestinal mucosa , microorganisms from the intestinal tract enter the peripheral blood circulation through the gut – liver axis and enter the ascites , causing abdominal infection . 6 The prevalence of spontaneous bacterial peritonitis ( SBP ) in in-patients with liver cirrhosis and ascites was approximately 10 %– 15 % and one-year mortality was 34 %. 7 , 8 Clinical manifestations of SBP are not specific . The most typical clinical manifestations are fever , abdominal pain , abdominal tenderness , and rebound tenderness . Some patients do not have obvious clinical manifestations and symptoms . Early warning , timely diagnosis and precise treatment are important for reducing abdominal infection and optimising the management of ascites in patients with liver cirrhosis .
Diagnosis of abdominal infection in liver cirrhosis Pathogens of abdominal infection include bacteria , fungi and viruses , and can be simple or multiplepathogen infections . Abdominal bacterial infection in patients with liver cirrhosis includes secondary bacterial peritonitis ( SBP ) and bacterascites .
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