Physiopathology of Liver cirrhosis: A Growing Public Health Concern in Sub-Saharan Africa
Authors: Nignan Nouhoun , Traoré Lassina , Simone Traoré Marie , Marius Nagalo Bolni , Ouattara Abdoul Karim , Ouédraogo Rogomenoma Alice , Ouédraogo Teega-Wendé Clarisse , Abel Sorgho Pingdwende , Compaoré Tégwindé Rebeca , Véronique Zongo Sidnooma , Bado Prosper , Djigma Florencia Wendkuuni , Théophane Yonli Albert , Simporé Jacques 
Published: December 2023

This study aims to comprehensively review the literature pertaining to the management of liver diseases, especially cirrhosis in sub-Saharan Africa. Specifically, it involves a meticulous synthesis and analysis of data concerning the physiopathology of liver cirrhosis, an assessment of the clinical manifestations associated with the condition, and an exploration of the presence and efficacy of therapeutic approaches utilizing conventional medicinal plants. The present study investigation included studies published between 2017 and 2022, focusing on the physiopathology of liver cirrhosis, primarily attributed to HBV and HCV etiologies. Additionally, we examine clinical manifestations and investigate the therapeutic potential of plant-derived remedies for liver cirrhosis. Inclusion criteria encompassed clinical studies, clinical trial protocols, and evaluation studies, while studies concurrently involving cirrhosis, HIV, and Covid-19, as well as reviews, correspondences, books, and case reports were excluded. A total of twenty-one articles were selected for this review. Physiopathology of liver cirrhosis: the collective evidence underscores the role of chronic hepatitis B virus (HBV) infection as a risk factor for liver cirrhosis. Age distribution within the cirrhotic population ranged from 18 to 71 years, with a predominance of male patients (ranging from 58.89% to 91%). Disease progression revealed distinct phases encompassing fibrosis, compensated cirrhosis, and decompensated cirrhosis culminating in the definitive establishment of liver cirrhosis. Ultimately, liver cirrhosis was associated to mortality due to hepatocellular carcinoma (HCC). Clinical manifestations of liver cirrhosis: analytical parameters encompassed serum, plasma, liver, total blood, and spleen evaluations. Serological tests involved liver biochemical markers (ALT, AST, TBIL, ALB, AFP, Bilirubin, PT, GGT), Antigens and/or Antibodies (HBsAg, HBeAg, Anti-HBs, anti-HBe), blood cell and lymphoid cell assessments (blood count, PLT), T lymphocytes, NK-Cells, Neutrophils, Leukocytes, Erythrocytes), HBV DNA, cytokines (IFN, IL, TNF, TGF), and creatinine levels. The patient demographics encompassed those with Hepatitis B-induced cirrhosis, patients with chronic HBV infection, those with concurrent HBV infection and liver fibrosis/cirrhosis, co-positive HBsAg/Anti-HBs individuals, single-positive HBsAg patients, individuals with prolonged positive HBsAg status, patients with compensated HBV-associated cirrhosis, individuals with hepatotoxicity, and patients with chronic liver disease. Existence and utility of a therapeutic management based on traditional drugs: several studies highlight the presence of treatment modalities utilizing traditional recipes. Notable among these are "erzhu jiedu," Echinacea-based formulations, and Curcumin-based regimens. This study compiled a comprehensive dataset comprising liver cirrhosis, encompassing its physiopathology, clinical manifestations, and the feasibility of therapeutic interventions grounded in traditional medicine. These findings provide importants insights for future research endeavors, potentially endorsing the adoption of traditional medicinal recipes while concurrently assessing the biological parameters elucidated in this study.