{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T03:09:34Z","timestamp":1787022574630,"version":"build-2736575974"},"reference-count":17,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2019,12,5]],"date-time":"2019-12-05T00:00:00Z","timestamp":1575504000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["JGH Open"],"published-print":{"date-parts":[[2020,6]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Additional hepatologists are required to manage the rapidly increasing number of patients with liver disease. One disincentive to trainees considering a career in hepatology is the longstanding perception that outpatient hepatology consists largely of managing patients with alcohol\u2010induced liver disease (ALD).<\/jats:p><\/jats:sec><jats:sec><jats:title>Objectives<\/jats:title><jats:p>To document the types of liver diseases and changes in liver disease referrals to an urban outpatient liver disease clinic over the past 25\u2009years.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The nature of the liver disorder, age, gender, and socioeconomic status of patients referred to an urban, hospital\u2010based, liver diseases outpatient program were documented from 1992 to 2017. Joinpoint analysis was performed to identify significant trends in referral prevalence rates of various disorders.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In 1992\/1993, hepatitis C virus (HCV), followed by hepatitis B virus (HBV), \u201cother\u201d, non\u2010alcoholic fatty liver disease (NAFLD), and primary biliary cholangitis (PBC) were the most common underlying liver diseases in referred patients (39, 36, 12, 4.5, and 3.5% respectively), whereas in 2016\/2017, NAFLD, HBV, HCV, \u201cother,\u201d and ALD were most common (60, 15, 12, 8.7, and 3.3%, respectively). Aside from NAFLD referrals, which consistently increased over the 25\u2010year period, the prevalence of all other liver disease referrals fluctuated but generally declined. Recently referred patients were significantly older (38\u2009\u00b1\u200913\u2009years in 1992\/1993 and 49 \u00b1\u200915\u2009years in 2016\/2017, <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.0001), while gender and socioeconomic status have not changed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Hepatology is a diverse, dynamic subspecialty where ALD continues to constitute less than 5% of all patient referrals.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jgh3.12286","type":"journal-article","created":{"date-parts":[[2019,12,6]],"date-time":"2019-12-06T05:50:02Z","timestamp":1575611402000},"page":"484-489","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Liver disease referrals to an urban, hospital\u2010based hepatology outpatient clinic over the past 25\u2009years"],"prefix":"10.1002","volume":"4","author":[{"given":"Micah","family":"Grubert Van Iderstine","sequence":"first","affiliation":[{"name":"Section of Hepatology, Department of Internal Medicine University of Manitoba  Winnipeg Manitoba Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Iluz\u2010Freundlich","sequence":"additional","affiliation":[{"name":"Section of Hepatology, Department of Internal Medicine University of Manitoba  Winnipeg Manitoba Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Casandra","family":"Dolovich","sequence":"additional","affiliation":[{"name":"Section of Hepatology, Department of Internal Medicine University of Manitoba  Winnipeg Manitoba Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eurielle","family":"Villarin","sequence":"additional","affiliation":[{"name":"Section of Hepatology, Department of Internal Medicine University of Manitoba  Winnipeg Manitoba Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2687-940X","authenticated-orcid":false,"given":"Gerald Y","family":"Minuk","sequence":"additional","affiliation":[{"name":"Section of Hepatology, Department of Internal Medicine University of Manitoba  Winnipeg Manitoba Canada"},{"name":"Department of Pharmacology and Therapeutics, Rady College of Medicine University of Manitoba  Winnipeg Manitoba 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