Evidence-based clinical practice guidelines for liver cirrhosis 2020
- PMID: 34228859
- DOI: 10.1111/hepr.13678
Evidence-based clinical practice guidelines for liver cirrhosis 2020
Abstract
The first edition of the clinical practice guidelines for liver cirrhosis was published in 2010, and the second edition was published in 2015 by the Japanese Society of Gastroenterology (JSGE). The revised third edition was recently published in 2020. This version has become a joint guideline by the JSGE and the Japanese Society of Hepatology (JSH). In addition to the clinical questions (CQs), background questions (BQs) are new items for basic clinical knowledge, and future research questions (FRQs) are newly added clinically important items. Concerning the clinical treatment of liver cirrhosis, new findings have been reported over the past 5 years since the second edition. In this revision, we decided to match the international standards as much as possible by referring to the latest international guidelines. Newly developed agents for various complications have also made great progress. In comparison with the latest global guidelines, such as the European Association for the Study of the Liver (EASL) and American Association for the Study of Liver Diseases (AASLD), we are introducing data based on the evidence for clinical practice in Japan. The flowchart for nutrition therapy was reviewed to be useful for daily medical care by referring to overseas guidelines. We also explain several clinically important items that have recently received focus and were not mentioned in the last editions. This digest version describes the issues related to the management of liver cirrhosis and several complications in clinical practice. The content begins with a diagnostic algorithm, the revised flowchart for nutritional therapy, and refracted ascites, which are of great importance to patients with cirrhosis. In addition to the updated antiviral therapy for hepatitis B and C liver cirrhosis, the latest treatments for non-viral cirrhosis, such as alcoholic steatohepatitis/non-alcoholic steatohepatitis (ASH/NASH) and autoimmune-related cirrhosis, are also described. It also covers the latest evidence regarding the diagnosis and treatment of liver cirrhosis complications, namely gastrointestinal bleeding, ascites, hepatorenal syndrome and acute kidney injury, hepatic encephalopathy, portal thrombus, sarcopenia, muscle cramp, thrombocytopenia, pruritus, hepatopulmonary syndrome, portopulmonary hypertension, and vitamin D deficiency, including BQ, CQ and FRQ. Finally, this guideline covers prognosis prediction and liver transplantation, especially focusing on several new findings since the last version. Since this revision is a joint guideline by both societies, the same content is published simultaneously in the official English journal of JSGE and JSH.
Keywords: complications; diagnosis; guidelines; liver cirrhosis; treatment.
This article has been co-published with permission in Hepatology Research and Journal of Gastroenterology. © 2021 The Authors. This article is published under the Creative Commons CC-BY licence. The articles are identical except for minor stylistic and spelling differences in keeping with each journal's style. Either citation can be used when citing this article.
Comment in
-
East meets West: what opportunities arise in comparing international guidelines for management of cirrhosis?Hepatobiliary Surg Nutr. 2023 Feb 28;12(1):121-123. doi: 10.21037/hbsn-22-602. Epub 2023 Jan 11. Hepatobiliary Surg Nutr. 2023. PMID: 36860255 Free PMC article. No abstract available.
Similar articles
-
Evidence-based clinical practice guidelines for Liver Cirrhosis 2020.J Gastroenterol. 2021 Jul;56(7):593-619. doi: 10.1007/s00535-021-01788-x. Epub 2021 Jul 7. J Gastroenterol. 2021. PMID: 34231046 Free PMC article. Review.
-
Evidence-based clinical practice guidelines for cholelithiasis 2021.J Gastroenterol. 2023 Sep;58(9):801-833. doi: 10.1007/s00535-023-02014-6. Epub 2023 Jul 15. J Gastroenterol. 2023. PMID: 37452855 Free PMC article. Review.
-
Evidence-based clinical practice guidelines for liver cirrhosis 2015.J Gastroenterol. 2016 Jul;51(7):629-50. doi: 10.1007/s00535-016-1216-y. Epub 2016 May 31. J Gastroenterol. 2016. PMID: 27246107 Review.
-
Evidence-based clinical practice guidelines for management of colorectal polyps.J Gastroenterol. 2021 Apr;56(4):323-335. doi: 10.1007/s00535-021-01776-1. Epub 2021 Mar 12. J Gastroenterol. 2021. PMID: 33710392 Free PMC article. Review.
-
Usefulness of nutritional therapy recommended in the Japanese Society of Gastroenterology/Japan Society of Hepatology evidence-based clinical practice guidelines for liver cirrhosis 2020.J Gastroenterol. 2021 Oct;56(10):928-937. doi: 10.1007/s00535-021-01821-z. Epub 2021 Sep 17. J Gastroenterol. 2021. PMID: 34533633
Cited by
-
Therapeutic effect of autologous bone marrow cells injected into the liver under the guidance of B‑ultrasound in the treatment of HBV‑related decompensated liver cirrhosis.Exp Ther Med. 2022 Aug 22;24(4):633. doi: 10.3892/etm.2022.11570. eCollection 2022 Oct. Exp Ther Med. 2022. PMID: 36160909 Free PMC article.
-
Alcohol-associated liver disease increases the risk of muscle loss and mortality in patients with cirrhosis.J Gastroenterol. 2024 Oct;59(10):932-940. doi: 10.1007/s00535-024-02137-4. Epub 2024 Jul 28. J Gastroenterol. 2024. PMID: 39068612 Free PMC article.
-
Serum zinc levels as predictors of covert hepatic encephalopathy in patients with liver cirrhosis.J Gastroenterol. 2025 Jan;60(1):96-106. doi: 10.1007/s00535-024-02160-5. Epub 2024 Oct 16. J Gastroenterol. 2025. PMID: 39412575
-
Drainage of ascites in cirrhosis.World J Hepatol. 2024 Sep 27;16(9):1245-1257. doi: 10.4254/wjh.v16.i9.1245. World J Hepatol. 2024. PMID: 39351514 Free PMC article. Review.
-
Modification of the ALBI-PLT Score for the Prediction of High-risk Varices.In Vivo. 2022 May-Jun;36(3):1360-1366. doi: 10.21873/invivo.12839. In Vivo. 2022. PMID: 35478164 Free PMC article.
References
REFERENCES
-
- Fukui H, Saito H, Ueno Y, et al. Evidence-based clinical practice guidelines for liver cirrhosis 2015. J Gastroenterol. 2016;51:629-650.
-
- Higgins JPT, Thomas J, Chandler J. Cochrane andbook for ystematic eviews of nterventions version 6.0. 2019. https://train ing.cochrane.org/handbook/current.
-
- Guyatt G, Oxman AD, Akl EA, et al. GRADE guidelines: 1. Introduction-GRADE evidence profiles and summary of findings tables. J Clin Epidemiol. 2011;64:383-394.
-
- Guyatt GH, Oxman AD, Kunz R, et al. GRADE guidelines: 2. Framing the question and deciding on important outcomes. J Clin Epidemiol. 2011;64:395-400.
-
- Guyatt GH, Oxman AD, Kunz R, et al. GRADE guidelines 6. Rating the quality of evidence-imprecision. J Clin Epidemiol. 2011;64 (12):1283-1293.
Grants and funding
LinkOut - more resources
Full Text Sources
Research Materials
Miscellaneous