Recommendations developed for preventive care in cirrhosis

Recommendations have been developed for preventive care of patients with cirrhosis, according to clinical guidelines published online Oct. 5 in the American Journal of Gastroenterology.

Elliot B. Tapper, M.D., from the University of Michigan in Ann Arbor, and colleagues developed guidelines for preventive care for patients with cirrhosis. The guidelines included 18 recommendations and six key concept statements relating to the domains of prevention of cirrhosis-specific complications, infection prevention, lifestyle factors and non-liver-specific conditions.

According to the guidelines, strong recommendations were made for carvedilol or variceal ligation of high-risk esophageal varices; semiannual surveillance for hepatocellular carcinoma; testing and vaccination for hepatitis A and B; immunization for influenza, severe acute respiratory syndrome coronavirus 2 and respiratory syncytial virus; and counseling for smoking cessation.

Lactulose for minimal hepatic encephalopathy, adjunctive rifaximin after hospitalization, prophylaxis with short-course antibiotics for upper gastrointestinal bleeding, behavioral therapy for alcohol use disorder after discharge, dietitian-guided nutrition, structured exercise and bisphosphonates for osteoporosis were included as conditional recommendations. The evidence was mostly of low certainty.

“The recommendations presented here span multiple clinical domains and touch the care of patients with cirrhosis across a variety of settings, making a deliberate and multifaceted implementation strategy essential,” the authors write.

Two authors disclosed ties to the biopharmaceutical industry.

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