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Abstract

Potential conflict of interest: Nothing to report. Author names in bold designate shared co‐first authorship. We thank Dr. Qi et al. for their positive comments about our special article in Hepatology.1 Beyond the contents discussed in our paper, these authors mentioned the discrepancy and similarity in diagnosis and treatment of Budd‐Chiari syndrome (BCS) between Western countries and China. In particular, Qi et al. suggested that the difference in clinical characteristics and etiology may be associated with the choice of suitable treatment options for BCS. To better recognize how the discrepancy influences the outcome of disease progression and treatment efficacy, there is an urgent need to strengthen translational study on liver diseases including BCS between China and Western countries. Budd‐Chiari syndrome is a rare, heterogeneous, and potentially fatal disease associated with the occlusion of hepatic veins and/or the suprahepatic inferior vena cava.2 There is a distinct geographic variation in BCS incidence between Asia and Western countries, being only lower than 1 to 2 per million inhabitants in Western countries.3 Over the past decades BCS has been frequently reported in China; however, national data on incidence and prevalence of BCS in the Chinese population are not available. The literature reports that BCS is more frequent in Henan, Shandong, Jiangsu, and Anhui Provinces in the Yellow River valley compared to other regions in China.5 The clinical characteristics and etiology of BCS patients in China are similar to those of patients in India and Nepal but significantly different from those of Western patients.3 Idiopathic forms, combined membranous occlusion of the inferior vena cava and the hepatic veins, and higher incidence of hepatocellular carcinoma are typical features of most Chinese BCS patients.5 In addition, selection of treatment modalities for BCS patients is different between China and Western countries.3 Chinese patients with BCS are usually treated using percutaneous transluminal angioplasty and have a similar good clinical outcome to Western patients, who often are treated with transjugular intrahepatic portosystemic shunt plus long‐term anticoagulants.9 As an update, there have been around 3000 articles on BCS in China, but the real prevalence might be higher than estimated due to increased awareness and improved diagnostic methods in China. However, duplicate publications about BCS in China both in English‐language journals and in Chinese‐language journals are relatively common.11 We should pay more attention to this situation in meta‐analyses and systemic reviews of this syndrome.