Abstract

The management algorithms for patients with liver cirrhosis

Given the large percentage of patients suffering from liver cirrhosis and the continued high death rate, liver cirrhosis remains an essential clinical issue. Nowadays, there are non-invasive diagnostic tools available which allow assessing the stage of fibrosis associated with chronic liver diseases to help identify high-risk patients and implement prevention algorithms. The decompensation of liver cirrhosis is linked with a substantially higher rate of mortality associated with portal hypertension as the main determinant of disease progression. Beta-blockers play a major role in the primary prevention. There are several complications of the disease, such as ascites, bacterial infections, esophageal and gastric varices, hepatic encephalopathy, hepatorenal syndrome, etc. New strategies for their management seem to have improved the survival outcomes, however, decompensation is always related to a poor prognosis. A great number of promising clinical trials concerning prevention and alternative therapies in cirrhosis complications are underway and they will hopefully bring some more effective treatment options in the near future.

Piśmiennictwo

1. Cheemerla S, Balakrishnan M. Global Epidemiology of Chronic Liver Disease. Clinical Liver Disease 2021;17(5):365-70

2. GBD 2017 Cirrhosis Collaborators. The global, regional, and national burden of cirrhosis by cause in 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet Gastroenterol Hepatol 2020;5:245-66

3. Hartleb M. Marskość wątroby. W: Dąbrowski A. Wielka Interna. Gastroenterologia. Część 1. Wyd. 2. Warszawa: Medical Tribune Polska, 2019:643-52

4. EASL. EASL-ALEH Clinical Practice Guidelines: Non-invasive tests for evaluation of liver disease severity and prognosis. J Hepatol 2015;63:237-64

5. Milkiewicz P. Elastografia wątroby w codziennej praktyce klinicznej. Gastroenterologia Kliniczna 2017;9(1):1-6

6. De Franchis R, Bosch J, Garcia-Tsao G, et al. Baveno VII – Renewing consensus in portal hypertension. J Hepatol 2022;76:959-74

7. Villanueva C, Albillos A, Genesca J, et al. β blockers to prevent decompensation of cirrhosis in patients with clinically significant portal hypertension (PREDESCI): a randomised, double-blind, placebo-controlled, multicentre trial. Lancet 2019;393(10191):1597-608

8. Simonetto DA, Liu M, Kamath PS. Portal Hypertension and Related Complications: Diagnosis and Management. Mayo Clin Proc 2019;94(4):714-26

9. Bosch J, Gracia-Sancho J, Abraldes JG. Cirrhosis as new indication for statins. Gut 2020;69:953-62

10. Kreidieha M, Hamadia R, Alsheikhb M, et al. Statin Use in Patients With Chronic Liver Disease and Cirrhosis: Current Evidence and Future Directions. Gastroenterol Res 2022;15(1):1-12

11. Biggins SW, Angeli P, Garcia-Tsao G, et al. Diagnosis, Evaluation, and Management of Ascites, Spontaneous Bacterial Peritonitis and Hepatorenal Syndrome: 2021 Practice Guidance by the American Association for the Study of Liver Diseases. Hepatology 2021;74(2):1014-48

12. EASL. EASL Clinical Practice Guidelines for the management of patients with decompensated cirrhosis. J Hepatol 2018;69:406-60

13. Mücke MM, Mücke VT, Graf C, et el. Efficacy of Norfloxacin Prophylaxis to Prevent Spontaneous Bacterial Peritonitis: A Systematic Review and Meta-Analysis. Clin Transl Gastroenterol 2020;11(8):e00223

14. Lesmana CRA, Raharjo M, Gani RA. Managing liver cirrhotic complications: Overview of esophageal and gastric varices. Clin Mol Hepatol 2020;26(4):444-60

15. Orzeł A, Marcisz C. Układ krążenia w marskości wątroby – aspekty patofizjologiczne. Kardiologia po Dyplomie 2011;10(9):58-65

16. Gralnek IM, Camus Duboc M, Garcia-Pagan JC, et al. Endoscopic diagnosis and management of esophagogastric variceal hemorrhage: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2022;54(11):1094-120

17. Rose CF, Amodio P, Bajaj JS, et al. Hepatic encephalopathy: Novel insights into classification, pathophysiology and therapy. J Hepatol 2020;73:1526-47

18. EASL. EASL Clinical Practice Guidelines on the management of hepatic encephalopathy. J Hepatol 2022;77:807-24

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