The findings of Roberts and colleagues¹ in this issue of Gut show a lack of improvement in liver cirrhosis mortality during the years 1968 to 1999 (see page 1615). This must be provoking, disappointing, and sobering reading for many.

Roberts and colleagues¹ based their findings on 8192 patients admitted to hospitals in the Oxford region of Southern England. The analyses were based on discharge and death certificate statistics. One year after admittance, the mortality rate was 34%, and remained so during the entire 30 year observation period. One year after admittance, the standardised mortality rate was 16.3 times that of the general population. These findings were robust to different analytical strategies. The disappointing results during the 30 year period were obtained both for the total group of 8192 patient admissions as well as for the diagnostic subgroups individually. The data show how deadly liver cirrhosis has been and continues to be.

Why does cirrhosis mortality remain unaffected despite our impression that it is decreasing? We expect decreasing mortality due to the use of many new interventions. Interventions such as liver transplantation,² endoscopic treatment for bleeding varices,^3,4 prevention of bleeding and rebleeding from varices with beta blockers,^3,4 antiviral drugs for hepatitis B or C,^5,6 and antibiotics for preventing and treating complications to cirrhosis,^3,7–9 have all been introduced during the study period.

Three major causes may explain the contrast between the finding of no significant …