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Review
. 2024 Aug 5:12:goae072.
doi: 10.1093/gastro/goae072. eCollection 2024.

Advances in the management of complications from cirrhosis

Jasleen Singh  1   2 , Mark Ebaid  1 , Sammy Saab  1   2
Affiliations
Review

Advances in the management of complications from cirrhosis

Jasleen Singh et al. Gastroenterol Rep (Oxf). .

Abstract

Cirrhosis with complications of liver decompensation and hepatocellular carcinoma (HCC) constitute a leading cause of morbidity and mortality worldwide. Portal hypertension is central to the progression of liver disease and decompensation. The most recent Baveno VII guidance included revision of the nomenclature for chronic liver disease, termed compensated advanced chronic liver disease, and leveraged the use of liver stiffness measurement to categorize the degree of portal hypertension. Additionally, non-selective beta blockers, especially carvedilol, can improve portal hypertension and may even have a survival benefit. Procedural techniques with interventional radiology have become more advanced in the management of refractory ascites and variceal bleeding, leading to improved prognosis in patients with decompensated liver disease. While lactulose and rifaximin are the preferred treatments for hepatic encephalopathy, many alternative treatment options may be used in refractory cases and even procedural interventions such as shunt embolization may be of benefit. The approval of terlipressin for the treatment of hepatorenal syndrome (HRS) in the USA has improved the way in which HRS is managed and will be discussed in detail. Malnutrition, frailty, and sarcopenia lead to poorer outcomes in patients with decompensated liver disease and should be addressed in this patient population. Palliative care interventions can lead to improved quality of life and clinical outcomes. Lastly, the investigation of systemic therapies, in particular immunotherapy, has revolutionized the management of HCC. These topics will be discussed in detail in this review.

Keywords: hepatocellular carcinoma; liver cirrhosis; liver failure.

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Conflict of interest statement

S.S. is in the speaker bureau for Salix, Eisai, Takeda, and AbbVie. He is also a speaker and advisor to Mallinckrodt and Gilead.

Figures

Figure 1.
Figure 1.
Pathophysiology of portal hypertension in cirrhosis.
Figure 2.
Figure 2.
Use of liver stiffness measurement in the diagnosis and management of cACLD. aAdapted from reference [5]. cACLD = compensated advanced chronic liver disease, CSPH = clinically significant portal hypertension.
Figure 3.
Figure 3.
Algorithm for variceal surveillance in patients with cirrhosis and portal hypertension. aWithout prior variceal hemorrhage. NSBB = non-selective beta blocker, EVL = endoscopic variceal ligation.
Figure 4.
Figure 4.
ATO and RTO techniques for the treatment of gastric varices
Figure 5.
Figure 5.
Indications for primary prophylaxis in spontaneous bacterial peritonitis (SBP).
See this image and copyright information in PMC

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