KASL clinical practice guidelines for liver cirrhosis: Varices, hepatic encephalopathy, and related complications

Abstract

clinical practice. Therefore, these revised guidelines for the treatment of varices and HE are offered for Korean practice to reflect the latest research results and extensive discussions within the revision committee. This guideline contains the opinions of experts and is intended to be a practical reference for the care of patients with varices and HE; it is not an absolute standard of care. The best choices for each patient's care vary from case to case, and the judgment of the doctor in charge is important. As medical evidence and new findings accumulate in the future, these guidelines will require ongoing supplementation and revision. This guideline may not be modified or altered without permission. Target population This guideline discusses patients with varices, HE, and related complications (esophageal varices [EVs] and bleeding, gastric varices and bleeding, portal hypertensive gastropathy, covert and overt HE) caused by liver cirrhosis. It is intended for clinicians and other medical personnel who are in charge of diagnosing and treating patients with liver cirrhosis. This guideline is also intended to provide practical clinical and educational information and directions for resident physicians and fellows in training, practitioners, and their trainers and supervisors. Development, funding, and revision process Comprising 14 hepatologists, the Clinical Practice Guideline Committee for Liver Cirrhosis: Varices, HE, and related complications (the Committee) was organized by the KASL Board of Executives. Funding for the revisions was provided by KASL. Each committee member collected and analyzed source data in his or her own field, and the members then wrote the manuscript together. Literature review The Committee selected keywords and questions using PICO (Patient/Problem, Intervention, Comparison, Outcome) assessments and systematically collected and reviewed international and domestic literature available in PubMed, MEDLINE, Kore-aMed, the Korean Medical Database, and other databases. In addition to published articles, abstracts of important meetings published before January 2019 were evaluated.

Association between Lipid Profiles and the Incidence of Hepatocellular Carcinoma: A Nationwide Population-Based Study

“…Serum lipid profiles can be altered in patients with chronic liver disease. Some studies have suggested that lipid disorders in patients with liver disease reflect the status of hepatic cellular impairment [ 9 ].…”

Hepatocellular Carcinoma Risk According to Regimens for Eradication of Hepatitis C Virus; Interferon or Direct Acting Antivirals

“…PegIFN/RBV or DAA regimens were prescribed according to the practice guideline [ 20 , 21 ] and SVR was defined as undetectable serum HCV-RNA with a lower limit of quantification of 15 IU/mL at 24 or 12 weeks after PegIFN/RBV or DAA regimens, respectively. If histologic information was not available, cirrhosis was clinically defined as follows: (1) platelet count <150,000/μL and ultrasonographic findings suggestive of cirrhosis, including a blunted, nodular liver edge accompanied by splenomegaly (>12 cm); or (2) esophageal or gastric varices [ 22 ].…”

Novel Insights Into Pathogenesis and Therapeutic Strategies of Hepatic Encephalopathy, From the Gut Microbiota Perspective

“…According to epidemiological investigations, the prevalence of HE is approximately 30 to 45%, which is accompanied by an increase in mortality ( Patidar and Bajaj, 2015 ; Xu et al., 2019 ). In the United States, the economic burden of hospitalization for HE amounts to more than $11.9 billion each year ( Hirode et al., 2019 ), which causes significant increases in patient mobility, morbidity, and care utilization ( Jang et al., 2020 ).…”