Natural History of Cirrhosis

G. Garcia-Tsao () Digestive Diseases Section, Yale University School of Medicine and VA-CT Healthcare System, 333 Cedar Street—1080 LMP, New Haven, CT 06510, USA e-mail: [email protected] Cirrhosis is considered the end stage of chronic liver disease of any etiology with a broad spectrum of clinical manifestations that are due to portal hypertension and/or liver insufficiency. The gold standard in the diagnosis of cirrhosis is considered histological and is characterized by a disrupted liver architecture secondary to regenerative nodules surrounded by fibrous septa. Once cirrhosis is established, it has been considered that the process is progressive and irreversible with an inevitable progression to death unless liver transplantation (LT) is performed. Cirrhosis had also been considered a single entity with a continuum of increasing degrees of severity and common predictors of death. These paradigms have shifted in recent years [1] as described in the following paragraphs.