Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 21, 2021; 27(19): 2281-2298
Published online May 21, 2021. doi: 10.3748/wjg.v27.i19.2281
Individualized treatment options for patients with non-cirrhotic and cirrhotic liver disease
Lukas Hartl, Joshua Elias, Gerhard Prager, Thomas Reiberger, Lukas W Unger
Lukas Hartl, Thomas Reiberger, Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna A-1090, Austria
Lukas Hartl, Thomas Reiberger, Vienna Hepatic Hemodynamic Lab, Medical University of Vienna, Vienna A-1090, Austria
Joshua Elias, Lukas W Unger, Cambridge Institute of Therapeutic Immunology and Infectious Disease, Jeffrey Cheah Biomedical Centre, University of Cambridge, Cambridge CB2 0AW, United Kingdom
Joshua Elias, Division of Gastroenterology and Hepatology, Department of Medicine, University of Cambridge, Addenbrooke’s Hospital, Cambridge CB2 0QQ, United Kingdom
Gerhard Prager, Lukas W Unger, Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna A-1090, Austria
Author contributions: Hartl L, Elias J and Unger LW performed literature review, prepared figures and tables and wrote the manuscript; Prager G and Reiberger T gave important intellectual input; all authors contributed intellectually, critically revised the manuscript and approved the final version of the manuscript.
Supported by Austrian Science Fund FWF, No. J4396; and Wellcome Trust PhD Fellowship for Clinicians, No. UNS59491.
Conflict-of-interest statement: LH, JE, GP and LWU declare no conflicts of interest related to this manuscript. TR received grant support from Abbvie, Boehringer-Ingelheim, Gilead, MSD, Philips Healthcare, Gore; speaking honoraria from Abbvie, Gilead, Gore, Intercept, Roche, MSD; consulting/advisory board fee from Abbvie, Bayer, Boehringer-Ingelheim, Gilead, Intercept, MSD, Siemens; and travel support from Abbvie, Boehringer-Ingelheim, Gilead and Roche.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Lukas W Unger, MD, PhD, Doctor, Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Währinger Gürtel 18-20, Vienna A-1090, Austria.
Received: January 24, 2021
Peer-review started: January 24, 2021
First decision: March 7, 2021
Revised: March 19, 2021
Accepted: April 25, 2021
Article in press: April 25, 2021
Published online: May 21, 2021
Core Tip

Core Tip: No single therapy fits all needs, sometimes resulting in complex clinical decision making. While some etiologies can distinctly be characterized, a multifactorial disease such as metabolic dysfunction-associated fatty liver disease requires thorough assessment of comorbidities and severity of concomitant fibrosis to assess a patient’s overall risk. While (guided) physical exercise is usually safe and well tolerated and strict treatment of diabetes and dyslipidemia is warranted, patients often fail to change their lifestyle, resulting in life-long drug dependency for comorbidities. Bariatric surgery has therefore become a valid option for obese patients and should be offered in eligible patients before liver fibrosis develops.