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Monday June 26th, 2017

Jaume Bosch coordinates the guidance on the management of portal hypertensive bleeding in cirrhosis published in Hepatology

Hepatology, the official journal of the American Association for the Study of Liver Diseases, has published a practice guidance entitled Portal Hypertensive Bleeding in Cirrhosis: Risk Stratification, Diagnosis, and Management. The study is coordinated by Dr. Jaume Bosch, hepatologist at Hospital Clínic and head of the research team Liver hemodynamics and portal hypertension at IDIBAPS. The other three authors, Dr. Juan G. Abraldes and Dr. Annalisa Berzigotti, are former IDIBAPS researchers, and Dr. Guadalupe Garcia-Tsao made a stay at this institution. The main newness of this guidance is the adaptation of the treatments to the various phases of cirrhosis.

The document that publishes Hepatology is a vision of experts who advise on how to interpret the current knowledge in the management of bleeding by portal hypertension in cirrhosis. “The difference between the standard recommendations and this type of guidance is that here we give an opinion on how to adopt different criteria, the degree of evidence of certain established ideas, etc.,” comments Dr. Bosch, adding that ” This guidance has a hight-impact because any doctor who treats portal hypertensive bleeding in cirrhosis must know it“.

The guidance appears at a time of paradigm shift. Until now, all treatments of portal hypertension (HP) were directed to control hemorrhages due to esophageal varices, which are the main complication that causes. Nowadays, thanks to advances in the knowledge of hepatic mechanisms, it has been possible to stratify the various stages of cirrhosis, which has allowed, on the one hand, to adapt treatments and, on the other hand, to find preventive therapies. Thus, mortality from esophageal varices has been drastically reduced: “Thirty years ago it was 45%,” says Dr. Bosch, “and now it is 15 or less, there are very few areas in medicine that can be compared with these advances“.

The guidance also gives some suggestions about the way which future research should be directed. Dr. Bosch says that “we have a very important path to make early treatments, and we are seeing possibilities to act more and more ahead, for example in the modification of lifestyles.

Reference:

Portal hypertensive bleeding in cirrhosis: Risk stratification, diagnosis, and management: 2016 practice guidance by the American Association for the study of liver diseases.

Guadalupe Garcia-Tsao; Juan G. Abraldes, Annalisa Berzigotti i Jaume Bosch.

Hepatology. 2017 Jan;65(1):310-335. DOI: 10.1002/hep.28906.

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