Journal of Gastroenterology

, Volume 45, Issue 1, pp 86–94

Etiology of liver cirrhosis in Japan: a nationwide survey

  • Kojiro Michitaka
  • Shuhei Nishiguchi
  • Yutaka Aoyagi
  • Yoichi Hiasa
  • Yoshio Tokumoto
  • Morikazu Onji
  • The Japan Etiology of Liver Cirrhosis Study Group
Original Article—Liver, Pancreas, and Biliary Tract

DOI: 10.1007/s00535-009-0128-5

Cite this article as:
Michitaka, K., Nishiguchi, S., Aoyagi, Y. et al. J Gastroenterol (2010) 45: 86. doi:10.1007/s00535-009-0128-5



Little is understood about worldwide changes in the epidemiological distribution of the etiology of liver cirrhosis (LC). The present study examines the etiology of liver cirrhosis in Japan using a nationwide survey.


We analyzed data from 33,379 patients with LC at 58 hospitals and presented the findings in a poster symposium regarding the etiology and clinical features of LC in Japan that was included in the program of the 44th Annual Meeting of the Japan Society of Hepatology. We identified the distribution of the etiology of LC and compared the present with previous Japanese findings to estimate the future of etiological changes in LC.


The etiological agents were as follows: hepatitis B virus (HBV) 13.9%, hepatitis C virus (HCV) 60.9%, alcohol 13.6%, primary biliary cirrhosis (PBC) 2.4% and autoimmune hepatitis (AIH) 1.9%. Cirrhosis was considered to be related to nonalcoholic steatohepatitis (NASH) in 2.1% of the patients. The ratio of HCV-related LC was significantly higher among patients with hepatocellular carcinoma (HCC) (P < 0.0001) compared to those without, whereas the ratios of alcohol, PBC, AIH were lower. HCC was evident in 31.5% of NASH-related LC.


The major etiology of liver cirrhosis in Japan remains HCV. Our survey revealed the prevalence of NASH-related LC in Japan and the frequency of HCC. Future changes in etiology must be considered in establishing preventive or educational strategies, as well as in developing new treatment strategies.


Carcinogenesis Hepatitis B virus Hepatitis C virus Hepatocellular carcinoma Nonalcoholic steatohepatitis 



Autoimmune hepatitis


Anti-nuclear antibody


Body mass index


Diabetes mellitus


Hepatitis B virus


Hepatocellular carcinoma


Hepatitis C virus


Liver cirrhosis


Metabolic syndrome


Nonalcoholic fatty liver disease


Nonalcoholic steatohepatitis


Primary biliary cirrhosis


Primary sclerosing cholangitis

Copyright information

© Springer 2009

Authors and Affiliations

  • Kojiro Michitaka
    • 1
  • Shuhei Nishiguchi
    • 2
  • Yutaka Aoyagi
    • 3
  • Yoichi Hiasa
    • 1
  • Yoshio Tokumoto
    • 1
  • Morikazu Onji
    • 1
  • The Japan Etiology of Liver Cirrhosis Study Group
  1. 1.Department of Gastroenterology and MetabologyEhime University Graduate School of MedicineToonJapan
  2. 2.Division of Hepatobiliary and Pancreatic Disease, Department of Internal MedicineHyogo College of MedicineNishinomiyaJapan
  3. 3.Division of Gastroenterology and HepatologyGraduate School of Medical and Dental Sciences of Niigata UniversityNiigataJapan

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