Management of patients with cirrhosis in Southern California: results of a practitioner survey.

Abstract

INTRODUCTION:

Cirrhosis is an important medical and public health concern. A paucity of data exists on how patients with cirrhosis are managed. Our aims were to determine how cirrhosis is managed and whether current management practices follow established recommendations.

METHODS:

A questionnaire was mailed to Southern California Society of Gastroenterology members. Most had practiced for more than 15 years (67%) in a private practice setting (69%). Proportions of physicians who followed established guidelines versus those who had not were compared using chi test.

RESULTS:

Hepatitis A, hepatitis B, influenza, and pneumococcus vaccinations were recommended by most respondents. Ninety-one percent of respondents routinely screened patients for hepatocellular carcinoma. A significantly greater proportion of respondents screened for hepatocellular carcinoma using either alpha-fetoprotein or ultrasound every 6 months (P < 0.05). Seventy-six percent recommended antibiotic prophylaxis in patients with prior spontaneous bacterial peritonitis, whereas less than half recommended prophylaxis in patients with ascitic protein fluid <1 g/dL, current variceal bleed, and those on the liver transplant list. Sixty-seven percent of respondents performed screening esophagogastroduodenoscopy upon diagnosis of cirrhosis. Most respondents did not recommend repeating endoscopy in 1 to 2 years if a patient was found to have small varices (P < 0.05), and would repeat an endoscopy if large varices were found (P < 0.05).

CONCLUSION:

The management of patients with cirrhosis in the community varied and did not always conform to established guidelines. These results should be confirmed in a larger group of physicians, and the rationales for physicians accepting or rejecting established guidelines should be further assessed.

• Authors: Sammy Saab, Stephen Nguyen, Ayman Ibrahim, John M Vierling, Myron J Tong
• Journal: Journal of clinical gastroenterology (J Clin Gastroenterol) Vol. 40 Issue 2 Pg. 156-61 (Feb 2006) ISSN: 0192-0790 [Print] United States
• PMID: 16394878 (Publication Type: Journal Article)

Topics

• California (epidemiology)
• Chi-Square Distribution
• Female
• Humans
• Liver Cirrhosis (epidemiology, therapy)
• Male
• Practice Patterns, Physicians' (statistics & numerical data)
• Surveys and Questionnaires