Abstract：
Chronic liver disease (CLD) is a persistent public health burden, with over one billion cases reported worldwide. In most cases, the progression of CLD is slow and undulating with end-stage liver disease developing at variable time points depending on the underlying etiology of the disease. The concept of reversibility or halting progression to end stage liver disease is recent and various medications are in the pipeline which influence the progression of CLD. Non-invasive tests for monitoring of CLD may have the potential to avoid the morbidity and mortality related to invasive procedures. However, their applicability and validation in pediatrics requires further development and a coordinated effort by large pediatric liver centres. Recent advances in metabolomics and modern molecular technologies have led to an understanding of the interaction between gut microbiome liver axis and gut dysbiosis contributing to liver diseases. In the future, modifying the gut microbiome has the potential to change the outcome and significantly reduce the morbidity associated with CLD. This article focuses on newer modalities and concepts in the management of CLD, which may help develop strategies to prevent its progression to end-stage liver disease and associated morbidity/mortality.
摘要：
慢性肝病（CLD）是一种持续的公共卫生负担，全球报告了超过10亿例病例。在大多数情况下,CLD的进展缓慢且起伏，终末期肝病在不同的时间点发展，具体取决于疾病的潜在病因。可逆性或停止进展至终末期肝病的概念是最新的,并且各种药物正在影响CLD的进展。用于监测CLD的非侵入性测试可能具有避免与侵入性程序相关的发病率和死亡率的潜力。然而,它们在儿科中的适用性和有效性需要进一步发展,并需要大型儿科肝脏中心的协调努力.代谢组学和现代分子技术的最新进展导致了对肠道微生物组肝轴和肠道生态失调之间相互作用的理解。在未来,改变肠道微生物组有可能改变结果并显著降低与CLD相关的发病率.本文重点介绍CLD管理中更新的模式和概念，这可能有助于制定策略，以防止其进展为终末期肝病和相关的发病率/死亡率。
