Díaz Luis Antonio, Ayares Gustavo, Arnold Jorge, Idalsoaga Francisco, Corsi Oscar, Arrese Marco, Arab Juan Pablo
Departamento de Gastroenterologia, Escuela de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile.
Centro de Envejecimiento Y Regeneración (CARE), Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile.
Curr Treat Options Gastroenterol. 2022;20(3):261-278. doi: 10.1007/s11938-022-00382-1. Epub 2022 Jun 16.
To assess the current challenges regarding liver diseases, including the burden of disease, access to care, screening, and treatment needs in Latin America.
Latin America is a region with a rich multicultural heritage and important socioeconomic differences. The burden of liver diseases is high and mainly determined by a high level of alcohol intake and the surge of risk factors associated with NAFLD (i.e., sedentary lifestyles, broader access to highly processed foods, obesity, and type 2 diabetes mellitus). Hepatotropic viruses also play a role in the development of chronic liver diseases, although their comparative frequency has been decreasing over the last decades. There are important disparities in access to screening and treatment for liver diseases in Latin America, which are reflected in low access to critical treatments such as direct-acting antiviral agents and drugs to treat hepatocellular carcinoma. Also, important barriers to liver transplantation are present in multiple countries, including a low deceased donors' rate and a lack of availability in several countries (especially in Central America). Our region also has disadvantages in research and education in liver diseases, which limits regional academic development and improvement in quality of care of liver diseases.
In order to tackle an increasing health burden due to liver diseases, Latin America urgently needs tailored interventions aiming to control the main risk factors for these disorders through the establishment of effective public health policies. Also, development of liver transplantation programs and improvement of medical education and research capabilities as well as extensive collaboration between all stakeholders are keys to address the liver disease agenda in the region.
评估拉丁美洲在肝脏疾病方面当前面临的挑战，包括疾病负担、医疗服务可及性、筛查以及治疗需求。
拉丁美洲是一个拥有丰富多元文化遗产且社会经济差异显著的地区。肝脏疾病负担沉重，主要由高酒精摄入量以及与非酒精性脂肪性肝病相关的风险因素激增所致（即久坐的生活方式、更容易获取深加工食品、肥胖症和2型糖尿病）。嗜肝病毒在慢性肝病的发展中也起作用，尽管在过去几十年中其相对发病率一直在下降。拉丁美洲在肝脏疾病筛查和治疗的可及性方面存在重大差异，这体现在获取直接抗病毒药物和治疗肝细胞癌药物等关键治疗手段的机会较低。此外，多个国家存在肝脏移植的重大障碍，包括脑死亡供体率低以及一些国家（尤其是中美洲国家）缺乏肝脏供体。我们地区在肝脏疾病研究和教育方面也存在劣势，这限制了区域学术发展以及肝脏疾病医疗质量的提升。
为应对因肝脏疾病导致的日益增加的健康负担，拉丁美洲迫切需要量身定制的干预措施，旨在通过制定有效的公共卫生政策来控制这些疾病的主要风险因素。此外，发展肝脏移植项目、提高医学教育和研究能力以及所有利益相关者之间的广泛合作是解决该地区肝脏疾病议程的关键。
