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.