BACKGROUND: It is estimated that 1 million persons in Germany suffer from hepatic cirrhosis, which is the final stage of chronic inflammation of the liver. Cirrhosis has multiple causes, all of which lead to structural changes of the liver and to portal hypertension. The main complications of cirrhosis arise in turn: These include bleeding from collateral veins, ascites, hepatocellular carcinoma, encephalopathy, and infection leading to organ failure. METHODS: We present the treatment of the main complications of liver cirrhosis with reference to the relevant literature (phase II and III trials, meta-analyses, and reviews). RESULTS: Endoscopic treatment (ligation) is used for the primary and secondary prophylaxis of variceal bleeding. Drugs to lower portal pressure (e.g., beta-blockers) are an established means of preventing initial or recurrent variceal bleeding over the long term. Vasoconstrictors such as terlipressin are mainly used to treat acute hemorrhage and type 1 hepatorenal syndrome. The main treatment of ascites is with spironolactone, in combination with a loop diuretic where indicated. A shunt (TIPS) is used to treat severe or repeat variceal hemorrhage or refractory ascites. Antibiotics play a well-established role in the treatment of acute hemorrhage, in the treatment and prevention of spontaneous bacterial peritonitis, and in the treatment of encephalopathy. The treatment of hepatocellular carcinoma depends on its extent of spread and on the degree of decompensation of cirrhosis. CONCLUSION: For most of the main complications of liver cirrhosis, there are treatments that have been well-tested in randomized trials. Liver transplantation should also be considered in every case.
BACKGROUND: It is estimated that 1 million persons in Germany suffer from hepatic cirrhosis, which is the final stage of chronic inflammation of the liver. Cirrhosis has multiple causes, all of which lead to structural changes of the liver and to portal hypertension. The main complications of cirrhosis arise in turn: These include bleeding from collateral veins, ascites, hepatocellular carcinoma, encephalopathy, and infection leading to organ failure. METHODS: We present the treatment of the main complications of liver cirrhosis with reference to the relevant literature (phase II and III trials, meta-analyses, and reviews). RESULTS: Endoscopic treatment (ligation) is used for the primary and secondary prophylaxis of variceal bleeding. Drugs to lower portal pressure (e.g., beta-blockers) are an established means of preventing initial or recurrent variceal bleeding over the long term. Vasoconstrictors such as terlipressin are mainly used to treat acute hemorrhage and type 1 hepatorenal syndrome. The main treatment of ascites is with spironolactone, in combination with a loop diuretic where indicated. A shunt (TIPS) is used to treat severe or repeat variceal hemorrhage or refractory ascites. Antibiotics play a well-established role in the treatment of acute hemorrhage, in the treatment and prevention of spontaneous bacterial peritonitis, and in the treatment of encephalopathy. The treatment of hepatocellular carcinoma depends on its extent of spread and on the degree of decompensation of cirrhosis. CONCLUSION: For most of the main complications of liver cirrhosis, there are treatments that have been well-tested in randomized trials. Liver transplantation should also be considered in every case.
Authors: M Rössle; A Ochs; V Gülberg; V Siegerstetter; J Holl; P Deibert; M Olschewski; M Reiser; A L Gerbes Journal: N Engl J Med Date: 2000-06-08 Impact factor: 91.245
Authors: Javier Sola-Vera; Josep Miñana; Elena Ricart; Montserrat Planella; Begoña González; Xavier Torras; Jose Rodríguez; José Such; Sonia Pascual; Germán Soriano; Miguel Pérez-Mateo; Carlos Guarner Journal: Hepatology Date: 2003-05 Impact factor: 17.425
Authors: Peter Ferenci; Alan Lockwood; Kevin Mullen; Ralph Tarter; Karin Weissenborn; Andres T Blei Journal: Hepatology Date: 2002-03 Impact factor: 17.425
Authors: Bernhard Angermayr; Manfred Cejna; Franz Koenig; Franz Karnel; Franz Hackl; Alfred Gangl; Markus Peck-Radosavljevic Journal: Hepatology Date: 2003-10 Impact factor: 17.425
Authors: Michael Schepke; Gerhard Kleber; Dieter Nürnberg; Jörg Willert; Lydia Koch; Wilfried Veltzke-Schlieker; Claus Hellerbrand; Johannes Kuth; Stefan Schanz; Stefan Kahl; Wolfgang E Fleig; Tilman Sauerbruch Journal: Hepatology Date: 2004-07 Impact factor: 17.425