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. 2023 Sep;135(Suppl 3):493-523.
doi: 10.1007/s00508-023-02229-w. Epub 2023 Jun 26.

Austrian consensus on the diagnosis and management of portal hypertension in advanced chronic liver disease (Billroth IV)

Mattias Mandorfer  1   2 , Elmar Aigner  3 , Manfred Cejna  4 , Arnulf Ferlitsch  5 , Christian Datz  6 , Tilmann Gräter  7 , Ivo Graziadei  8 , Michael Gschwantler  9 , Stephanie Hametner-Schreil  10 , Harald Hofer  11 , Mathias Jachs  12   13 , Alexander Loizides  14 , Andreas Maieron  15 , Markus Peck-Radosavljevic  16 , Florian Rainer  17 , Bernhard Scheiner  12   13 , Georg Semmler  12   13 , Lukas Reider  18 , Silvia Reiter  19 , Maria Schoder  18 , Rainer Schöfl  10 , Philipp Schwabl  12   13 , Vanessa Stadlbauer  17 , Rudolf Stauber  17 , Elisabeth Tatscher  17 , Michael Trauner  12 , Alexander Ziachehabi  19 , Heinz Zoller  20 , Peter Fickert  17 , Thomas Reiberger  21   22
Affiliations

Austrian consensus on the diagnosis and management of portal hypertension in advanced chronic liver disease (Billroth IV)

Mattias Mandorfer et al. Wien Klin Wochenschr. 2023 Sep.

Abstract

The Billroth IV consensus was developed during a consensus meeting of the Austrian Society of Gastroenterology and Hepatology (ÖGGH) and the Austrian Society of Interventional Radiology (ÖGIR) held on the 26th of November 2022 in Vienna.Based on international recommendations and considering recent landmark studies, the Billroth IV consensus provides guidance regarding the diagnosis and management of portal hypertension in advanced chronic liver disease.

Keywords: Acute-on-chronic liver failure; Ascites; Cirrhosis; Elastography; HVPG; Hepatorenal syndrome; Portal vein thrombosis; Spontaneous bacterial peritonitis; Transjugular intrahepatic portosystemic shunt; Variceal bleeding; Varices.

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Conflict of interest statement

M. Mandorfer served as a speaker and/or consultant and/or advisory board member for AbbVie, Albireo, Collective Acumen, Gilead, Takeda, and W. L. Gore & Associates and received travel support from AbbVie and Gilead. E. Aigner served as a speaker and/or consultant and/or advisory board member for Gilead, Sanofi-Genzyme, Takeda, Advanz Pharma, Roche, Novartis. B. Scheiner received travel support fromm AbbVie, Ipsen and Gilead. M. Gschwantler received grants from AbbVie, Gilead, and MSD; speaking honoraria/advisory board fees from AbbVie, Gilead, MSD, Janssen, BMS, Roche, Intercept, Alnylam, Norgine, AstraZeneca, Falk, Gebro Pharma and Shionogi. M. Jachs served as a speaker and/or consultant for Gilead and received travel support from Gilead. S. Hametner-Schreil served as speaker and/or advisory board member for AbbVie, Gilead, Roche and MSD. M. Peck-Radosavljevic has served as an investigator for AstraZeneca, Bayer, BMS, Boehringer Ingelheim, Exelixis, Eisai, Gilead, Lilly, Ipsen, Novartis, and Roche. He has served as speaker or adviser for AstraZeneca, Bayer, BMS, Boehringer Ingelheim, Eisai, Gilead, Ipsen, Lilly, MSD, and Roche. He received grant support from Bayer and Gilead, and he served in data and safety monitoring boards for BMS, Boehringer Ingelheim, Lilly-Imclonse and ONEXO. P. Schwabl served as constultant for PharmaIN. R. Stauber served as a speaker for Boston Scientific and Medtronic. S. Reiter received speakers’ honoraria from Intercept Pharma Austria as well as travel support from AbbVie and Gilead. M. Trauner received grant support from Albireo, Alnylam, Cymabay, Falk, Gilead, Intercept, MSD, Takeda, and UltraGenyx, honoraria for consulting from Albireo, Boehringer Ingelheim, BiomX, Falk, Genfit, Gilead, Hightide, Intercept, Janssen, MSD, Novartis, Phenex, Pliant, Regulus, and Shire, speaker fees from Bristol-Myers Squibb, Falk, Gilead, Intercept, and MSD, as well as travel support from AbbVie, Falk, Gilead, Intercept and Jannsen. V. Stadlbauer received speaker’s honoraria and travel support from Merz Therapeutics, Albireo, Sanofi. T. Reiberger served as a speaker and/or consultant and/or advisory board member speaking honoraria from AbbVie, Bayer, Boehringer-Ingelheim, Gilead, Intercept, MSD, Roche, Siemens, and W. L. Gore & Associates and received travel support from AbbVie, Boehringer-Ingelheim, Gilead, and Roche as well as grants/research support from AbbVie, Boehringer-Ingelheim, Gilead, Intercept, MSD, Myr Pharmaceuticals, Philips Healthcare, Pliant, Siemens, and W. L. Gore & Associates. M. Cejna, A. Ferlitsch, C. Datz, T. Gräter, I. Graziadei, H. Hofer, A. Loizides, A. Maieron, F. Rainer, , G. Semmler, L. Reider, M. Schoder, R. Schöfl, E. Tatscher, A. Ziachehabi, H. Zoller and P. Fickert declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
CSPH can be ruled-out or ruled-in by assessing LSM (by VCTE) and PLT and applying the Baveno VII criteria. Patients within the grey zone of the Baveno VII criteria may be reclassified by von Willebrand factor (VWF) to platelet count (PLT) ratio (VITRO) or spleen stiffness measurement SSM (by VCTE). Patients with inconclusive non-invasive findings should be evaluated by hepatic venous pressure gradient (HVPG)-measurement and/or endoscopy for the presence of clinically significant portal hypertension (CSPH) and varices (which are confirmative of CSPH), respectively. Alternative (i.e., non-VCTE-based) strategies, should limited to settings where VCTE is not available
Fig. 2
Fig. 2
Therapeutic algorithm for the management of advanced chronic liver disease (ACLD) patients presenting with upper gastrointestinal bleeding (UGIB)
Fig. 3
Fig. 3
Diagnosis, staging, and management of AKI and in patients with cirrhosis and ascites
See this image and copyright information in PMC

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