British Society of Gastroenterology Best Practice Guidance: outpatient management of cirrhosis – part 1: compensated cirrhosis
Dina Mansour, Steven Masson, Debbie L. Shawcross, Andrew Douds, Emily Bonner, Lynsey Corless, Joanna Leithead, John Hammond, Michael A. Heneghan, Mussarat N. Rahim, Dhiraj Tripathi, Rebecca West, Jill L. Johnson, Gemma Botterill, Coral Hollywood, Valerie Ross, Mhairi Donnelly, Juliet Compston, Stuart McPherson, Allison Grapes
Abstract
The prevalence of cirrhosis has risen significantly over recent decades and is predicted to rise further. Widespread use of non-invasive testing means cirrhosis is increasingly diagnosed at an earlier stage. Despite this, there are significant variations in outcomes in patients with cirrhosis across the UK, and patients in areas with higher levels of deprivation are more likely to die from their liver disease. This three-part best practice guidance aims to address outpatient management of cirrhosis, in order to standardise care and to reduce the risk of progression, decompensation and mortality from liver disease. Here, in part one, we focus on outpatient management of compensated cirrhosis, encompassing hepatocellular cancer surveillance, screening for varices and osteoporosis, vaccination and lifestyle measures. We also introduce a compensated cirrhosis care bundle for use in the outpatient setting. Part two concentrates on outpatient management of decompensated disease including management of ascites, encephalopathy, varices, nutrition as well as liver transplantation and palliative care. The third part of the guidance covers special circumstances encountered in managing people with cirrhosis: surgery, pregnancy, travel, managing bleeding risk for invasive procedures and portal vein thrombosis.