Recompensation Oriented Management of Chronic Liver Diseases in the Era of Metabolic and Viral Therapies
Keywords:
chronic liver disease, cirrhosis, portal hypertension, viral hepatitis, metabolic steatotic liver disease, liver transplantation, hepatic decompensation, recompensationAbstract
Chronic liver diseases encompass a spectrum from asymptomatic hepatic injury to cirrhosis with life‑threatening decompensation, and they now rank among the leading global causes of morbidity and mortality. Their etiological profile is rapidly shifting from viral hepatitis toward metabolic dysfunction–associated steatotic liver disease, alcohol‑related liver disease, and complex multimorbidity, while modern antivirals have transformed outcomes in viral hepatitis. Effective management integrates etiologic cure or control, prevention and treatment of portal hypertension and hepatocellular carcinoma, optimization of nutrition and sarcopenia, and timely referral for liver transplantation. Recent guidance emphasizes risk‑stratified surveillance, non‑invasive staging, and multidisciplinary, patient‑centered care to prevent progression and to promote “recompensation” even after decompensation. This narrative review summarizes contemporary concepts in epidemiology, pathophysiology, diagnosis, and comprehensive management of chronic liver diseases across compensated and decompensated stages, highlighting practical approaches applicable to everyday clinical practice.
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