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01-07-2016 | Special Article

Evidence-based clinical practice guidelines for liver cirrhosis 2015

Authors: Hiroshi Fukui, Hidetsugu Saito, Yoshiyuki Ueno, Hirofumi Uto, Katsutoshi Obara, Isao Sakaida, Akitaka Shibuya, Masataka Seike, Sumiko Nagoshi, Makoto Segawa, Hirohito Tsubouchi, Hisataka Moriwaki, Akinobu Kato, Etsuko Hashimoto, Kojiro Michitaka, Toshikazu Murawaki, Kentaro Sugano, Mamoru Watanabe, Tooru Shimosegawa

Published in: Journal of Gastroenterology | Issue 7/2016

Abstract

The Japanese Society of Gastroenterology revised the evidence-based clinical practice guidelines for liver cirrhosis in 2015. Eighty-three clinical questions were selected, and a literature search was performed for the clinical questions with use of the MEDLINE, Cochrane, and Igaku Chuo Zasshi databases for the period between 1983 and June 2012. Manual searching of the latest important literature was added until August 2015. The guidelines were developed with use of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. This digest version in English introduces selected clinical questions and statements related to the management of liver cirrhosis and its complications. Branched-chain amino acids relieve hypoalbuminemia and hepatic encephalopathy and improve quality of life. Nucleoside analogues and peginterferon plus ribavirin combination therapy improve the prognosis of patients with hepatitis B virus related liver cirrhosis and hepatitis C related compensated liver cirrhosis, respectively, although the latter therapy may be replaced by direct-acting antivirals. For liver cirrhosis caused by primary biliary cirrhosis and active autoimmune hepatitis, urosodeoxycholic acid and steroid are recommended, respectively. The most adequate modalities for the management of variceal bleeding are the endoscopic injection sclerotherapy for esophageal varices and the balloon-occluded retrograde transvenous obliteration following endoscopic obturation with cyanoacrylate for gastric varices. Beta-blockers are useful for primary prophylaxis of esophageal variceal bleeding. The V₂ receptor antagonist tolvaptan is a useful add-on therapy in careful diuretic therapy for ascites. Albumin infusion is useful for the prevention of paracentesis-induced circulatory disturbance and renal failure. In addition to disaccharides, the nonabsorbable antibiotic rifaximin is useful for the management of encephalopathy. Anticoagulation therapy is proposed for patients with acute-onset or progressive portal vein thrombosis.

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Title: Evidence-based clinical practice guidelines for liver cirrhosis 2015
Authors: Hiroshi Fukui
Hidetsugu Saito
Yoshiyuki Ueno
Hirofumi Uto
Katsutoshi Obara
Isao Sakaida
Akitaka Shibuya
Masataka Seike
Sumiko Nagoshi
Makoto Segawa
Hirohito Tsubouchi
Hisataka Moriwaki
Akinobu Kato
Etsuko Hashimoto
Kojiro Michitaka
Toshikazu Murawaki
Kentaro Sugano
Mamoru Watanabe
Tooru Shimosegawa
Publication date: 01-07-2016
Publisher: Springer Japan
Published in: Journal of Gastroenterology / Issue 7/2016
Print ISSN: 0944-1174
Electronic ISSN: 1435-5922
DOI: https://doi.org/10.1007/s00535-016-1216-y

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Evidence-based clinical practice guidelines for liver cirrhosis 2015

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