Liver diseases remain dramatically underestimated worldwide. At some point in life, almost everyone will experience elevated liver enzymes, and millions of people are affected by abnormalities in ALT or AST levels. More than 100 million individuals globally are living with liver cirrhosis, highlighting the enormous burden of liver diseases on healthcare systems. Despite these staggering numbers, awareness of liver diseases remains low, and many patients are diagnosed only at advanced stages when therapeutic options are limited.
In recent years, hepatology has undergone profound transformations, with rapid progress in both therapeutic and diagnostic advancements. The introduction of novel antiviral therapies for hepatitis B, C and D, targeted treatments for liver and bile-duct cancer, and innovations in metabolic and autoimmune liver diseases has reshaped the field. Furthermore, personalized medicine and non-invasive diagnostic tools have revolutionized clinical practice, enabling earlier and more precise disease detection and management. These developments emphasize the need for up-to-date, comprehensive educational resources to support clinicians in making informed decisions for their patients.
Against this backdrop, we are pleased to continue the success of the Hepatology – A clinical textbook, now in its 11th edition (2024–2025). This latest volume once again provides a complete overview of the most recent developments across the entire spectrum of hepatology, covering viral hepatitis, steatotic liver disease (SLD), rare liver diseases, cirrhosis-related complications, and hepatocellular carcinoma (HCC). The continuous evolution of the textbook reflects the dynamic nature of the field and ensures that it remains a reliable and relevant reference for clinicians, researchers, and students.
This edition is the result of a collaborative effort by numerous internationally renowned experts from leading hepatology centers in Germany and beyond. Their expertise and dedication have made it possible to update existing chapters and contribute entirely new sections, ensuring that this textbook remains an essential resource for those dedicated to the care of patients with liver diseases.
We extend our deepest gratitude to all contributors for their commitment to this project. We hope that this new edition will serve as a trusted guide in clinical hepatology and contribute to improving patient care worldwide.
The Editors
Heiner Wedemeyer, Stefan Mauss, Thomas Berg, Verena Keitel, Jürgen Rockstroh, and Christoph Sarrazin
Hepatology is a rapidly evolving field that will continue to grow and maintain excitement over the next few decades. Viral hepatitis is not unlike HIV 10 or 15 years ago. Today, hepatitis B viral replication can be suppressed by potent antiviral drugs, although there are risks regarding the emergence of resistance. Strategies to enhance the eradication rates of HBV infection still need to be developed. On the other hand, hepatitis C virus infection can be eradicated by treatment with pegylated interferon plus ribavirin, although the sustained virologic response rates are still suboptimal, particularly in those infected with genotype 1. Many new antiviral drugs, especially protease and polymerase inhibitors, are currently in clinical development, and the data from trials reported over the last few years provide optimism that the cure rates for patients with chronic hepatitis C will be enhanced with these new agents, and even that all-oral regimens are around the corner! In other areas of hepatology, e.g., hereditary and metabolic liver diseases, our knowledge is rapidly increasing and new therapeutic options are on the horizon.
In rapidly evolving areas such as hepatology, is the book format the right medium to gather and summarise the current knowledge? Are these books not likely to be outdated the very day they are published? This is indeed a challenge that can be convincingly overcome only by rapid internet-based publishing with regular updates. Another unmatched advantage of a web-based book is the free and unrestricted global access. Viral hepatitis and other liver diseases are a global burden and timely information is important for physicians, scientists, patients and health care officials all around the world.
The editors of this web-based book – Thomas Berg, Stefan Mauss, Jürgen Rockstroh, Christoph Sarrazin and Heiner Wedemeyer – are young, bright, and internationally renowned hepatologists who have created an excellent state-of-the-art textbook on clinical hepatology. The book is well-written and provides in-depth information without being lengthy or redundant. I am convinced that all five experts will remain very active in the field and will continue to update this book regularly as the science progresses. This e-book should rapidly become an international standard.
Stefan Zeuzem – Frankfurt, Germany, January 2009
Therapeutic options and diagnostic procedures in hepatology have quickly advanced during the last decade. In particular, the management of viral hepatitis has completely changed since the early nineties. Before nucleoside and nucleotide analogues were licensed to treat hepatitis B and before interferon α + ribavirin combination therapy were approved for the treatment of chronic hepatitis C, very few patients infected with HBV or HCV were treated successfully. The only option for most patients with end-stage liver disease or hepatocellular carcinoma was liver transplantation. And even if the patients were lucky enough to be successfully transplanted, reinfection of the transplanted organs remained major challenges. In the late eighties and early nineties discussions were held about rejecting patients with chronic hepatitis from the waiting list as posttransplant outcome was poor. Today, just 15 years later, hepatitis B represents one of the best indications for liver transplantations, as basically all reinfection can be prevented. In addition, the proportion of patients who need to be transplanted is declining − almost all HBV-infected patients can nowadays be treated successfully with complete suppression of HBV replication and some well-selected patients may even be able to clear HBsAg, the ultimate endpoint of any hepatitis B treatment.
Hepatitis C has also become a curable disease with a sustained response of 50–80% using pegylated interferons in combination with ribavirin. HCV treatment using direct HCV enzyme inhibitors has started to bear fruit (we draw your attention to the HCV chapters).
Major achievements for the patients do sometimes lead to significant challenges for the treating physician. Is the diagnostic work-up complete? Did I any recent development to evaluate the stage and grade of liver disease? What sensitivity is really necessary for assays to detect hepatitis viruses? When do I need to determine HBV polymerase variants, before and during treatment of hepatitis B? When can I safely stop treatment without risking a relapse? How to treat acute hepatitis B and C? When does a health care worker need a booster vaccination for hepatitis A and B? These are just some of many questions we have to ask ourselves frequently during our daily routine practice. With the increasing number of publications, guidelines and expert opinions it is getting more and more difficult to stay up-to-date and to make the best choices for the patients. That is why Hepatology − A clinical textbook is a very useful new tool that gives a state-of-the art update on many aspects of HAV, HBV, HCV, HDV and HEV infections. The editors are internationally-known experts in the field of viral hepatitis; all have made significant contributions to understanding the pathogenesis of virus-induced liver disease, diagnosis and treatment of hepatitis virus infections.
Hepatology − A clinical textbook gives a comprehensive overview on the epidemiology, virology, and natural history of all hepatitis viruses including hepatitis A, D and E. Subsequent chapters cover all major aspects of the management of hepatitis B and C including coinfections with HIV and liver transplantation. Importantly, complications of chronic liver disease such as hepatocellular carcinoma and recent developments in assessing the stage of liver disease are also covered. Finally, interesting chapters on autoimmune and metabolic non-viral liver diseases complete the book.
We are convinced that this new up-to-date book covering all clinically relevant aspects of viral hepatitis will be of use for every reader. The editors and authors must be congratulated for their efforts.
Michael P. Manns – Hannover, January 2009