Toward the Effective Co-management of Patients with Cirrhosis by Primary Care Providers and Specialists

Excerpt

The US population suffers from such a progressively high prevalence of many chronic diseases that it is now estimated that over half of all US adults suffer from one or more chronic medical conditions [1]. Cirrhosis is not only one of the most common chronic diseases, its prevalence is rising along with the overall mortality from liver disease, due mostly to preceding hepatitis C virus (HCV) infection, the aging of the hepatitis C-infected baby boomer cohort [2], continually high rates of alcohol abuse, chronic hepatitis B virus (HBV), and the epidemic of obesity and diabetes mellitus to which an estimated 20–40 % of the US population with nonalcoholic fatty liver disease (NAFLD) is attributed [3]. These chronic liver diseases, typically indolent and slowly progressive for decades, are similar to many other common chronic conditions that are largely asymptomatic in their initial phases, such as hypertension and kidney disease. If progression to cirrhosis is reached, the ultimate risk of decompensation and death is very high: It is estimated that 58 % of compensated cirrhosis patients will decompensate within 10 years at a rate of 12 % per year and that the median survival for decompensated patients is 2 years [4]. Currently, in the US, cirrhosis is the twelfth most common cause of death, with the increase in the incidence rate for hepatocellular carcinoma second among any malignancy [5]. …