Content area
Full Text
Cirrhosis is a diffuse process of liver damage considered irreversible in its advanced stages. In 2016, more than 40,000 Americans died because of complications related to cirrhosis, making it the 12th leading cause of death in the United States.1 Recent projections suggest that this number is likely to grow.2 An estimated 630,000 Americans have cirrhosis, yet less than one in three knows it.3 Important racial and socioeconomic disparities exist, with prevalence highest among non-Hispanic blacks, Mexican Americans, and those living below the poverty level.3 Cirrhosis and advanced liver disease cost the United States between $12 billion and $23 billion dollars in health care expenses annually.4,5
WHAT'S NEW ON THIS TOPIC
Cirrhosis
Estimates suggest that nonalcoholic steatohepatitis will become the leading cause of cirrhosis in U.S. patients awaiting liver transplantation sometime between 2025 and 2035.
Liver biopsy remains the reference standard; however, transient elastography has become more widely available and is rapidly replacing biopsy as the preferred method for liver fibrosis staging.
Newer guidelines suggest targeted screening for esophageal varices in patients with clinically significant portal hypertension rather than screening all patients with cirrhosis.
SORT: KEY RECOMMENDATIONS FOR PRACTICE
| Clinical recommendation | Evidence rating | Comments |
|---|---|---|
| Further evaluation of patients with clinical signs or symptoms of liver disease or abnormal liver function tests should be pursued to determine the potential etiology, regardless of duration of the abnormality.19,20 | C | Expert opinion and consensus guidelines in the absence of clinical trials |
| All patients with cirrhosis should be evaluated for hepatocellular carcinoma with ultrasonography every six months.43 | C | Expert opinion and consensus guidelines with low-quality trials |
| Patients with cirrhosis who have a Model for End-Stage Liver Disease score of 15 or more, or complications of cirrhosis that include ascites, hepatic encephalopathy, or variceal hemorrhage, should be referred to a transplant center.37 | B | Randomized controlled trials demonstrate acceptable survival benefits based on clinical criteria and Model for End-Stage Liver Disease results with some variability |
| Patients with clinically apparent (i.e., moderate to severe) ascites should be managed with salt restriction and spironolactone with or without loop diuretics.49 | B | Data from multiple randomized controlled trials demonstrate more benefit than harm regarding patient comfort and reduced hospitalization times |
| Patients with cirrhosis who have medium, large, or high-risk varices (red wale markings)... |