Reply
Authors: Zheng Zhang, Jian‐Gao Fan, Fu‐Sheng Wang
Journal: Hepatology (2015)

Potential conflict of interest: Nothing to report. Author names in bold designate shared co‐first authorship. We fully agree with the suggestions and comments from the letter entitled "Liver Disease in China: A Long Way to Go" by Yang et al. in this issue of Hepatology, which emphasizes the gaps between the current reality in clinical management of liver diseases and the great financial investment or the increasing publications related to liver disease in China. Frankly, we had similar concerns when we were preparing the special article.1 Over the past two decades, Chinese hepatologists and scientists have made great progress in liver disease research with the support of a large amount of funding from the government, especially the National Grand Program on Key Infectious Disease. These funds have been used not only for optimization of hepatitis B virus (HBV) vaccination strategies for high‐risk populations but also to explore better antiviral therapeutic approaches (e.g., combinations of various antiviral drugs) for the reduction of morbidity and mortality in patients with chronic HBV as well as other types of liver disease in China. These funds also have supported basic and translational research related to liver diseases, leading to many important discoveries including identification of the HBV receptor. However, translation of these discoveries into clinical practice and new treatments has been modest. Due to the lack of a national database for various liver diseases in China as mentioned in the letter, we used Beijing 302 Hospital data, as shown in Table 2, as an example to describe the epidemiological trend of liver diseases over the past decade, although these data may not precisely represent the realistic comprehensive status in China.2 Currently, several clinical centers have aimed at building different digital net platforms for a national database of liver diseases, such as the China Registry of Hepatitis B and the China Registry of Drug‐Induced Liver Injury (HepaTox) by the Chinese Association of Hepatology. We can anticipate that it will take more than 10 years to get the database well established for the national epidemiology of several major liver diseases in China. More comprehensive training for Chinese hepatologists and global collaboration with Western countries are required to complete the establishment of this database and the translation of basic research discoveries into clinical practice. As mentioned in the letter, unfortunately, discrimination against HBV carriers indeed exists in China. To eliminate this discrimination, we should begin large‐scale dissemination of scientific knowledge about liver diseases in China. Recently, the Chinese Association of Hepatology has issued two guidelines to educate the general public about what HBV and fatty liver disease are and how to diagnose and manage them. It is necessary to perform regular medical examinations for liver cirrhosis and hepatocellular carcinoma in high‐risk populations. We should set up a long‐term follow‐up protocol for patients with various liver diseases, which is very important for the future investigation of liver disease outcome and preventive treatment. Taken together, although we have made great progress in the basic research on liver diseases with the support of national and regional government funding, there is a long way to go to achieve effective and better management of liver diseases in China. We should strengthen national and global collaborative research, efforts to establish a national liver disease database, and public health education. In future, more outputs and achievements from translational research will not only improve clinical practice for liver disease patients but also significantly benefit Chinese patients as well as patients with liver diseases around the world.