The Gastroenterologist's Guide to Preventive Management of Compensated Cirrhosis

Abstract

Despite advances in medical care, the prevalence and mortality associated with cirrhosis continue to rise. The majority of medical care and physician efforts are devoted to the management of decompensated cirrhosis and its complications of gastrointestinal hemorrhage, hepatic encephalopathy, and ascites; however, limited efforts are placed on the medical management of compensated cirrhosis. Patients with compensated cirrhosis carry a higher survival rate, and, when diagnosed early, may be screened for future decompensation. When possible, these patients can be treated for their underlying disease to prevent disease progression and avoid the need for liver transplantation. This article reviews the importance of early diagnosis, outpatient management of compensated cirrhosis, early screening for potential decompensation, and patient education.

Keywords: Compensated cirrhosis; gastroesophageal varices; hepatocellular carcinoma; malnutrition; patient education; polypharmacy.

Figure 1.

The natural course of cirrhosis. Complications of cirrhosis include portal hypertension, synthetic dysfunction, and hepatocellular carcinoma. Portal hypertension is considered clinically significant when hepatic venous pressure gradient (HVPG) is at least 10 mm Hg, leading to hepatic encephalopathy, varices, and ascites.

Figure 2.

All patients with cirrhosis should be screened for gastroesophageal varices, hepatocellular carcinoma, and disease severity by assessing synthetic dysfunction using the MELD-Na score. Patients should be educated on the importance of nutrition and immunization and avoid hepatotoxic drugs. AFP, α-fetoprotein; EGD, esophagogastroduodenoscopy; MELD-Na, Model for End-Stage Liver Disease with sodium.

Figure 3.

All patients with cirrhosis should be screened for varices and should undergo primary prophylaxis based on the size of their varices, high-risk bleeding stigmata, and severity of liver disease. CTP, Child-Turcotte-Pugh; EGD, esophagogastroduodenoscopy.