A survey of patients with cirrhosis admitted in hospital centers across Germany showed that the diagnosis of non-alcoholic fatty liver disease-induced cirrhosis has increased by four-fold during the last 14 years in parallel with an increase in the presence of adiposity. However, hepatitis C virus-induced cirrhosis has decreased at the same pace. Alcohol consumption remains by far the most frequent trigger for the development of cirrhosis, with 20-times as many hospital admissions compared to other causes. The study further revealed that complications of cirrhosis have also changed over time, with a significant decrease in bleeding of varices throughout the gastrointestinal tract. This could be explained by the wider implementation of the national and international guidelines on endoscopic procedures and treatment using non-selective beta-blockers and transjugular intrahepatic portosystemic shunt. On the other hand, decompensation episodes, mainly due to ascites, hepatic encephalopathy, and infections appeared to increase throughout this period.

Together, these findings indicate a pressing need for the development of treatment strategies to prevent or slow down the transition to decompensated cirrhosis in order to improve management of complications and care of patients with liver cirrhosis.

Other authors on the study are Wenyi Gu, Hannah Hortlik, Hans-Peter Erasmus, Louisa Schaaf, Yasmin Zeleke, Frank E. Uschner, Philip Ferstl, Martin Schulz, Kai-Henrik Peiffer, Alexander Queck, Tilman Sauerbruch, Maximilian Joseph Brol, Gernot Rohde, Cristina Sanchez, Richard Moreau, Vicente Arroyo, Stefan Zeuzem, and Christoph Welsch.