What are the AASLD treatment guidelines for cirrhosis?

Updated: Jul 30, 2018
  • Author: David C Wolf, MD, FACP, FACG, AGAF, FAASLD; Chief Editor: BS Anand, MD  more...
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Answer

Answer

For individuals with compensated cirrhosis and mild portal hypertension, the AASLD provides the following guidance [72] :

  • The treatment goal is to prevent the development of clinically significant portal hypertension (CSPH)/decompensation and, perhaps, even to achieve regression of cirrhosis.
  • Elimination of the etiologic agent is the current mainstay of therapy.
  • Drugs that act on portal flow, such as nonselective beta-blockers, will be mostly ineffective in this substage, given that the hyperdynamic circulatory state is not fully developed.

For individuals with compensated cirrhosis and CSPH but without gastroesophageal varices, the AASLD recommends the following [72] :

  • The goal of treatment should be to prevent clinical decompensation (ie, it is no longer the objective to prevent varices).
  • No evidence exists at present to recommend the use of nonselective beta-blockers to prevent the formation of varices.

In patients with compensated cirrhosis and gastroesophageal varices, AASLD recommendations include the following [72] :

  • Nonselective beta-blockers are the recommended therapy for patients with high-risk small esophageal varices (ie, primary prevention in patients with small esophageal varices).
  • Either traditional nonselective beta-blockers (eg, propranolol, nadolol), carvedilol, or endoscopic variceal ligation (EVL) is recommended for the prevention of first variceal hemorrhage (VH) (primary prophylaxis) in patients with medium or large varices.
  • Treatment selection should be based on patient preference and characteristics.
  • Patients on nonselective beta-blockers or carvedilol for primary prophylaxis do not require monitoring with serial esophagogastroduodenoscopy (EGD).
  • Not recommended in this setting: The combination therapy of nonselective beta-blockers plus EVL
  • Not recommended in the prevention of first VH: Transjugular intrahepatic portosystemic shunt (TIPS) placement

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