eISSN: 3087-405X editor@aimjournals.com
All Journals
Submit your article

International Research Journal of Medical Sciences and Health Care

Open Access Peer Review International
Open Access

RECENT DEVELOPMENTS IN THE TREATMENT AND MANAGEMENT OF LIVER CIRRHOSIS COMPLICATIONS

DOI https://doi.org/10.55640/irjmshc-v02i02-01
PDF
Dr. Freddy Becket 1 ,
4 Consultant Hepatologist, Liver Disease Research Center, Mayo Clinic, Rochester, MN

Abstract

Liver cirrhosis is a chronic and progressive liver disease characterized by the replacement of healthy liver tissue with scar tissue, leading to a decline in liver function. It is associated with significant morbidity and mortality, primarily due to complications such as portal hypertension, ascites, hepatic encephalopathy, variceal bleeding, and hepatocellular carcinoma (HCC). The causes of cirrhosis are multifactorial, including viral hepatitis, excessive alcohol consumption, non-alcoholic fatty liver disease (NAFLD), and autoimmune hepatitis. This article provides an updated overview of the pathophysiology, complications, and management of liver cirrhosis, with a focus on recent advancements in the field. Current treatments aim to prevent or manage complications, slow disease progression, and improve quality of life. Direct-acting antivirals (DAAs) for hepatitis C, novel pharmacological agents for managing ascites and portal hypertension, and advancements in liver transplantation have significantly improved outcomes. The management of cirrhosis remains a complex challenge, requiring a multidisciplinary approach that includes pharmacotherapy, interventional procedures, and, in some cases, liver transplantation. As the prevalence of cirrhosis continues to rise, especially with the increasing burden of metabolic diseases, ongoing research into antifibrotic therapies and liver regeneration strategies is crucial for improving the prognosis of patients with this condition.

Keywords

Liver Cirrhosis, Complications, Portal Hypertension

References

📄 Schuppan, D.; Afdhal, N.H. Liver Cirrhosis. Lancet 2008, 371, 838–851. [Google Scholar] [CrossRef] [PubMed]
📄 Huang, D.Q.; Terrault, N.A.; Tacke, F.; Gluud, L.L.; Arrese, M.; Bugianesi, E.; Loomba, R. Global Epidemiology of Cirrhosis-Aetiology, Trends and Predictions. Nat. Rev. Gastroenterol. Hepatol. 2023, 20, 388–398. [Google Scholar] [CrossRef] [PubMed]
📄 GBD 2016 Brain and Other CNS Cancer Collaborators. Global, Regional, and National Burden of Brain and Other CNS Cancer, 1990-2016: A Systematic Analysis for the Global Burden of Disease Study 2016. Lancet Neurol. 2019, 18, 376–393. [Google Scholar] [CrossRef] [PubMed]
📄 Flemming, J.A.; Djerboua, M.; Groome, P.A.; Booth, C.M.; Terrault, N.A. NAFLD and Alcohol-Associated Liver Disease Will Be Responsible for Almost All New Diagnoses of Cirrhosis in Canada by 2040. Hepatology 2021, 74, 3330–3344. [Google Scholar] [CrossRef] [PubMed]
📄 Nusrat, S.; Khan, M.S.; Fazili, J.; Madhoun, M.F. Cirrhosis and Its Complications: Evidence Based Treatment. World J. Gastroenterol. 2014, 20, 5442–5460. [Google Scholar] [CrossRef]
📄 Smethurst, K.; Gallacher, J.; Jopson, L.; Majiyagbe, T.; Johnson, A.; Copeman, P.; Mansour, D.; McPherson, S. Improved Outcomes Following the Implementation of a Decompensated Cirrhosis Discharge Bundle. Frontline Gastroenterol. 2022, 13, 409–415. [Google Scholar] [CrossRef]
📄 Kalaitzakis, E. Quality of Life in Liver Cirrhosis. In Handbook of Disease Burdens and Quality of Life Measures; Preedy, V.R., Watson, R.R., Eds.; Springer: New York, NY, USA, 2010; pp. 2239–2254. ISBN 978-0-387-78665-0. [Google Scholar]
📄 Iwakiri, Y. Pathophysiology of Portal Hypertension. Clin. Liver Dis. 2014, 18, 281–291. [Google Scholar] [CrossRef]
📄 Oliver, T.I.; Sharma, B.; John, S. Portal Hypertension. In StatPearls; StatPearls Publishing: Treasure Island, FL, USA, 2023. [Google Scholar]
📄 Shen, M.; Lee, A.; Lefkowitch, J.H.; Worman, H.J. Vibration-Controlled Transient Elastography for Assessment of Liver Fibrosis at a USA Academic Medical Center. J. Clin. Transl. Hepatol. 2022, 10, 197–206. [Google Scholar] [CrossRef]
📄 Meseeha, M.; Attia, M. Esophageal Varices. In StatPearls; StatPearls Publishing: Treasure Island, FL, USA, 2023. [Google Scholar]
📄 Shaheen, A.-A.; Nguyen, H.H.; Congly, S.E.; Kaplan, G.G.; Swain, M.G. Nationwide Estimates and Risk Factors of Hospital Readmission in Patients with Cirrhosis in the United States. Liver Int. 2019, 39, 878–884. [Google Scholar] [CrossRef]
📄 Moore, C.M.; Van Thiel, D.H. Cirrhotic Ascites Review: Pathophysiology, Diagnosis and Management. World J. Hepatol. 2013, 5, 251–263. [Google Scholar] [CrossRef]
📄 Runyon, B.A. AASLD Practice Guidelines Committee Management of Adult Patients with Ascites Due to Cirrhosis: An Update. Hepatology 2009, 49, 2087–2107. [Google Scholar] [CrossRef] [PubMed]
📄 Shahed, F.H.M.; Mamun-Al-Mahtab, N.; Rahman, S. The Evaluation of Serum Ascites Albumin Gradient and Portal Hypertensive Changes in Cirrhotic Patients with Ascites. Euroasian J. Hepatogastroenterol. 2016, 6, 8–9. [Google Scholar] [CrossRef] [PubMed]
📄 Fiati Kenston, S.S.; Song, X.; Li, Z.; Zhao, J. Mechanistic Insight, Diagnosis, and Treatment of Ammonia-Induced Hepatic Encephalopathy. J. Gastroenterol. Hepatol. 2019, 34, 31–39. [Google Scholar] [CrossRef] [PubMed]
📄 Levitt, D.G.; Levitt, M.D. A Model of Blood-Ammonia Homeostasis Based on a Quantitative Analysis of Nitrogen Metabolism in the Multiple Organs Involved in the Production, Catabolism, and Excretion of Ammonia in Humans. Clin. Exp. Gastroenterol. 2018, 11, 193–215. [Google Scholar] [CrossRef]
📄 Maraolo, A.E.; Gentile, I.; Pinchera, B.; Nappa, S.; Borgia, G. Current and Emerging Pharmacotherapy for the Treatment of Bacterial Peritonitis. Expert. Opin. Pharmacother. 2018, 19, 1317–1325. [Google Scholar] [CrossRef]
📄 MacIntosh, T. Emergency Management of Spontaneous Bacterial Peritonitis-A Clinical Review. Cureus 2018, 10, e2253. [Google Scholar] [CrossRef]
📄 Oey, R.C.; van Buuren, H.R.; de Jong, D.M.; Erler, N.S.; de Man, R.A. Bacterascites: A Study of Clinical Features, Microbiological Findings, and Clinical Significance. Liver Int. 2018, 38, 2199–2209. [Google Scholar] [CrossRef]
📄 Ng, C.K.; Chan, M.H.; Tai, M.H.; Lam, C.W. Hepatorenal Syndrome. Clin. Biochem. Rev. 2007, 28, 11–17. [Google Scholar]
📄 Orr, T.G.; Helwig, F.C. Liver trauma and the hepatorenal syndrome. Ann. Surg. 1939, 110, 682–692. [Google Scholar] [CrossRef]
📄 Arroyo, V.; Ginès, P.; Gerbes, A.L.; Dudley, F.J.; Gentilini, P.; Laffi, G.; Reynolds, T.B.; Ring-Larsen, H.; Schölmerich, J. Definition and Diagnostic Criteria of Refractory Ascites and Hepatorenal Syndrome in Cirrhosis. International Ascites Club. Hepatology 1996, 23, 164–176. [Google Scholar] [CrossRef]
📄 Amin, A.A.; Alabsawy, E.I.; Jalan, R.; Davenport, A. Epidemiology, Pathophysiology, and Management of Hepatorenal Syndrome. Semin. Nephrol. 2019, 39, 17–30. [Google Scholar] [CrossRef] [PubMed]
📄 Adebayo, D.; Wong, F. Pathophysiology of Hepatorenal Syndrome-Acute Kidney Injury. Clin. Gastroenterol. Hepatol. 2023, 21, S1–S10. [Google Scholar] [CrossRef] [PubMed]
📄 Egerod Israelsen, M.; Gluud, L.L.; Krag, A. Acute Kidney Injury and Hepatorenal Syndrome in Cirrhosis. J. Gastroenterol. Hepatol. 2015, 30, 236–243. [Google Scholar] [CrossRef] [PubMed]
📄 Angeli, P.; Ginès, P.; Wong, F.; Bernardi, M.; Boyer, T.D.; Gerbes, A.; Moreau, R.; Jalan, R.; Sarin, S.K.; Piano, S.; et al. Diagnosis and Management of Acute Kidney Injury in Patients with Cirrhosis: Revised Consensus Recommendations of the International Club of Ascites. J. Hepatol. 2015, 62, 968–974. [Google Scholar] [CrossRef]
📄 Benvegnù, L.; Gios, M.; Boccato, S.; Alberti, A. Natural History of Compensated Viral Cirrhosis: A Prospective Study on the Incidence and Hierarchy of Major Complications. Gut 2004, 53, 744–749. [Google Scholar] [CrossRef]
📄 Simonetti, R.G.; Cammà, C.; Fiorello, F.; Politi, F.; D’Amico, G.; Pagliaro, L. Hepatocellular Carcinoma. A Worldwide Problem and the Major Risk Factors. Dig. Dis. Sci. 1991, 36, 962–972. [Google Scholar] [CrossRef]
📄 Fattovich, G.; Stroffolini, T.; Zagni, I.; Donato, F. Hepatocellular Carcinoma in Cirrhosis: Incidence and Risk Factors. Gastroenterology 2004, 127, S35–S50. [Google Scholar] [CrossRef]
📄 Reddy, K.R.; McLerran, D.; Marsh, T.; Parikh, N.; Roberts, L.R.; Schwartz, M.; Nguyen, M.H.; Befeler, A.; Page-Lester, S.; Tang, R.; et al. Incidence and Risk Factors for Hepatocellular Carcinoma in Cirrhosis: The Multicenter Hepatocellular Carcinoma Early Detection Strategy (HEDS) Study. Gastroenterology 2023, 165, 1053–1063.e6. [Google Scholar] [CrossRef]
📄 Flemming, J.A.; Yang, J.D.; Vittinghoff, E.; Kim, W.R.; Terrault, N.A. Risk Prediction of Hepatocellular Carcinoma in Patients with Cirrhosis: The ADRESS-HCC Risk Model. Cancer 2014, 120, 3485–3493. [Google Scholar] [CrossRef]
📄 De Mitri, M.S.; Poussin, K.; Baccarini, P.; Pontisso, P.; D’Errico, A.; Simon, N.; Grigioni, W.; Alberti, A.; Beaugrand, M.; Pisi, E. HCV-Associated Liver Cancer without Cirrhosis. Lancet 1995, 345, 413–415. [Google Scholar] [CrossRef]
📄 Ramakrishna, G.; Rastogi, A.; Trehanpati, N.; Sen, B.; Khosla, R.; Sarin, S.K. From Cirrhosis to Hepatocellular Carcinoma: New Molecular Insights on Inflammation and Cellular Senescence. Liver Cancer 2013, 2, 367–383. [Google Scholar] [CrossRef] [PubMed]

Most read articles by the same author(s)

1 2 > >>