Evidence-based clinical practice guidelines for liver cirrhosis 2015

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 V 2 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.

Status of and candidates for cell therapy in liver cirrhosis: overcoming the “point of no return” in advanced liver cirrhosis

“…Owing to the severity of clinical symptoms, US, European [1][2][3][4], and Japanese clinical practice guidelines [5] have been developed for liver cirrhosis; these guidelines include standardized treatments such as nutrition therapy, antiviral therapy, management of portal hypertension, ascites, hepatorenal syndrome, hepatic encephalopathy, and portal thrombosis, and liver transplantation.…”

Clinical value of urinary retinol‑binding protein in ascites due to cirrhosis

“…A total of 90 patients with liver cirrhosis and ascites hospitalized in Shanghai Tenth People's Hospital of Tongji University (Shanghai, China) between May 2011 and January 2012 were enrolled in the present study. They all conformed to the standard diagnosis of cirrhosis (24). The exclusion criteria used for the present study was as follows: Patients with diabetes and/or high blood pressure; ascites formed 7-10 days after upper gastrointestinal bleeding; malignant ascites; and ascites were caused by right cardiac insufficiency and renal insufficiency.…”

Can Proteomic Profiling Identify Biomarkers and/or Therapeutic Targets for Liver Fibrosis?

“…However, this approach is limited because of the shortages of organs, the presence of concurrent disease affecting other tissues, and recurrence of the original disease in transplant patients [12]. Despite the advancement in noninvasive tests, liver biopsy still remains as the gold standard test for evaluation of liver disease severity [13][14][15][16]. However, it has several disadvantages such as invasive character, sampling errors and limitations for effective surveillance, and follow-up [17][18][19].…”