Liver cirrhosis in Bangladesh: a systematic review of etiology, complications and management gaps

Abstract

Liver cirrhosis represents a significant and growing cause of morbidity and mortality in Bangladesh, reflecting the increasing burden of chronic liver diseases in low- and middle-income countries. This systematic review aims to evaluate the current etiological patterns of cirrhosis in Bangladesh, summarize its major complications and clinical outcomes, and identify critical gaps in prevention and management. A comprehensive literature search was conducted across MEDLINE/PubMed, Scopus, Web of Science, Google Scholar, and BanglaJOL from database inception to August 29, 2025. Eligible studies included observational studies, clinical trials, and national reports involving Bangladeshi populations with chronic liver disease or cirrhosis. Study selection, data extraction, and quality assessment followed PRISMA 2020 guidelines. Due to substantial methodological heterogeneity, findings were synthesized narratively. Of 1,847 identified records, 62 studies met eligibility criteria. Most were single-center hospital-based cross-sectional studies from tertiary centers in Dhaka. Hepatitis B virus (HBV) remains the predominant etiology, accounting for 30-60% of cirrhosis cases, while hepatitis C virus (HCV) contributes 5-20%. Recent meta-analyses indicate a pooled HBV prevalence of 4.0% (95% CI: 3.0-5.1%) in the general population. Non-alcoholic fatty liver disease (NAFLD/MASLD) has emerged as a rapidly increasing cause, with community prevalence of 25-35% among adults, rising to over 50% in individuals with metabolic risk factors. Major health system challenges include inadequate HBV/HCV screening, limited access to endoscopy and liver transplantation, insufficient hepatocellular carcinoma (HCC) surveillance, and absence of structured NAFLD/MASLD management pathways. Bangladesh is experiencing an epidemiological transition from viral to metabolic causes of cirrhosis, necessitating strengthened viral hepatitis control, expanded metabolic disease prevention, improved specialist services, and establishment of standardized national surveillance programs.