Evidence-based clinical practice guidelines for liver cirrhosis 2020
Evidence-based clinical practice guidelines for liver cirrhosis 2020
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DOI：
10.1111/hepr.13678
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发表时间：
2021-07-06
影响因子：
4.2
通讯作者：
Koike, Kazuhiko
中科院分区：
文献类型：
--
作者：
Yoshiji, Hitoshi;Nagoshi, Sumiko;Koike, Kazuhiko
《肝硬化临床实践指南》第一版于2010年出版，第二版于2015年由日本消化学会（JSGE）出版。修订后的第三版最近于2020年出版。该版本已成为JSGE和日本肝病学会（JSH）的联合指南。除临床问题（cq）外，背景问题（bq）是新增的临床基础知识项目，未来研究问题（frq）是新增的临床重要项目。关于肝硬化的临床治疗，从第2版开始，近5年来不断有新的发现报道。在这次修订中，我们决定通过参考最新的国际指南，尽可能地与国际标准相匹配。新开发的治疗各种并发症的药物也取得了很大进展。与最新的全球指南（如欧洲肝脏研究协会（EASL）和美国肝脏疾病研究协会（AASLD））相比，我们正在介绍基于日本临床实践证据的数据。通过参考国外指南，审查了营养治疗流程图，使其对日常医疗保健有用。我们还解释了最近受到关注的几个临床重要项目，这些项目在上一版中没有提到。这个摘要版本描述的问题有关管理的肝硬化和几个并发症在临床实践。内容从诊断算法、修订的营养治疗流程图和折射性腹水开始，这对肝硬化患者非常重要。除了最新的乙型和丙型肝炎肝硬化抗病毒治疗外，还介绍了非病毒性肝硬化的最新治疗方法，如酒精性脂肪性肝炎/非酒精性脂肪性肝炎（ASH/NASH）和自身免疫相关肝硬化。它还涵盖了肝硬化并发症的诊断和治疗的最新证据，即胃肠道出血、腹水、肝肾综合征和急性肾损伤、肝性脑病、门静脉血栓、肌肉减少症、肌肉痉挛、血小板减少症、瘙痒症、肝肺综合征、门脉性肺动脉高压和维生素D缺乏症，包括BQ、CQ和FRQ。最后，本指南涵盖了预后预测和肝移植，特别关注自上一版以来的一些新发现。由于此次修订是由两个学会联合编写的指南，因此在JSGE和JSH的官方英文期刊上同时发表相同的内容。
The first edition of the clinical practice guidelines for liver cirrhosis was published in 2010, and the second edition was published in 2015 by the Japanese Society of Gastroenterology (JSGE). The revised third edition was recently published in 2020. This version has become a joint guideline by the JSGE and the Japanese Society of Hepatology (JSH). In addition to the clinical questions (CQs), background questions (BQs) are new items for basic clinical knowledge, and future research questions (FRQs) are newly added clinically important items. Concerning the clinical treatment of liver cirrhosis, new findings have been reported over the past 5 years since the second edition. In this revision, we decided to match the international standards as much as possible by referring to the latest international guidelines. Newly developed agents for various complications have also made great progress. In comparison with the latest global guidelines, such as the European Association for the Study of the Liver (EASL) and American Association for the Study of Liver Diseases (AASLD), we are introducing data based on the evidence for clinical practice in Japan. The flowchart for nutrition therapy was reviewed to be useful for daily medical care by referring to overseas guidelines. We also explain several clinically important items that have recently received focus and were not mentioned in the last editions. This digest version describes the issues related to the management of liver cirrhosis and several complications in clinical practice. The content begins with a diagnostic algorithm, the revised flowchart for nutritional therapy, and refracted ascites, which are of great importance to patients with cirrhosis. In addition to the updated antiviral therapy for hepatitis B and C liver cirrhosis, the latest treatments for non-viral cirrhosis, such as alcoholic steatohepatitis/non-alcoholic steatohepatitis (ASH/NASH) and autoimmune-related cirrhosis, are also described. It also covers the latest evidence regarding the diagnosis and treatment of liver cirrhosis complications, namely gastrointestinal bleeding, ascites, hepatorenal syndrome and acute kidney injury, hepatic encephalopathy, portal thrombus, sarcopenia, muscle cramp, thrombocytopenia, pruritus, hepatopulmonary syndrome, portopulmonary hypertension, and vitamin D deficiency, including BQ, CQ and FRQ. Finally, this guideline covers prognosis prediction and liver transplantation, especially focusing on several new findings since the last version. Since this revision is a joint guideline by both societies, the same content is published simultaneously in the official English journal of JSGE and JSH.