The article by Elliott Tapper, MD entitled “The Changing Face of Cirrhosis” is a must read. It was published April 15, 2026 in docwirenews.

Summary-

🔑 The Core Shift

Cirrhosis is no longer driven primarily by viral hepatitis. Metabolic disease is now the leading cause.

📊 Key Points

• MASLD (metabolic dysfunction–associated steatotic liver disease) is now the #1 cause of cirrhosis in the U.S. VHA population
• Hepatitis C-related cirrhosis is declining due to highly effective antiviral treatments
• Alcohol-related liver disease (ALD) is rising, including overlap with metabolic disease (MetALD)

⚠️ What’s Driving This Change

• Obesity & diabetes epidemic → surge in MASLD
• Improved HCV treatment → fewer viral cases
• Increasing alcohol use → rising ALD burden

🚨 Key Insight

• Alcohol-related cirrhosis is likely underestimated due to self-reporting

🏥 The Implications

• Shift toward metabolic risk management (weight loss, GLP-1s, cardiometabolic care)
• Need for routine alcohol use screening across all care settings
• Expansion of treatment for alcohol use disorder (e.g., naltrexone)
• Scaling successful systems (like VHA) to broader populations.