Management of patients with liver cirrhosis at outpatient stage: How not to miss it?

Liver cirrhosis is a disease gastroenterologists and therapists face daily, and not only in the hospital when it comes to treating complications, but also at outpatient appointments, when the disease is in the compensation stage. At the same time, in the age group of 20–40 years, mortality from liver cirrhosis (LC) exceeds that from coronary heart disease. Despite modern advances in intensive care and transplantation, the mortality rate in the development of liver failure remains high [1]. For example, in 2015, there were 1.3 million deaths from liver cirrhosis, of which 348,000 were caused by alcohol, 326,000 by hepatitis C, and 371,000 by hepatitis B [2]. The classic manifestations of cirrhosis leave no doubt in the diagnosis, however, a detailed history taking, active identification of risk factors at the stage of the latent course of liver cirrhosis can prevent many severe complications of this disease and reduce the number of hospitalizations.

1. O. V. Ryzhkova. Algorithm for the diagnosis and treatment of liver cirrhosis, p. 6.

2. Van H., Nagavi M., Allen K., Barber R. M., Bhutta Z. A., Carter A. et al. Global, regional and national life expectancy, all-cause mortality, and cause-specific mortality by 249 causes of death, 1980–2015: A systematic analysis for the study of the global burden of disease 2015. Lancet. 388 (10053): 1459–1544. DOI: 10.1016/s0140–6736(16)31012–1.

3. Clinical Guidelines. Cirrhosis and fibrosis of the liver. 2021–2022–2023 (01/21/2022). Pp. 20–24.

4. De Franchis R. Baveno VI faculty. Expanding consensus in portal hypertension: Report of the BAVENO VI Consensus Workshop: Stratifying risk and individualizing care for portal hypertension. J Hepatol 2015; 63: 743–52. DOI: 10.1016/j.jhep.2015.05.022.

5. Zatevakhin I. I., Ivashkin V. T., Kitsenko E. A., Pavlov Ch.S., Shercinger A. G., Zhao A. V. and others. National Clinical Guidelines of the Ministry of Health of Russia for the treatment of bleeding from varicose veins of the esophagus and stomach. Medical newspaper. 2015; 71–4.

6. Rus J Gastroenterol Hepatol Coloproctol 2021; 31 (6). С. 66–68.

7. Patidar K. R., Bajaj J. S. Covert and overt hepatic encephalopathy: Diagnosis and management. Clin Gastroenterol Hepatol. 2015 Nov.; 13 (12): 2048–61. DOI: 10.1016/j. Epub 2015 Jul 9.

8. Сhao A., Waitzberg D., de Jesus R. P., Bueno A. A., Kha V., Allen K., Kappus M., Medici V. Malnutrition and Nutritional Support in Alcoholic Liver Disease: A Review. Curr. Gastroenterol. Rep. 2016. No. 18 (12). Р. 65.

9. Santos J., Planas R., Pardo A., Durandez R., Cabre E., Morillas R. S., et al. Spironolactone alone or in combination with furosemide in the treatment of moderate ascites in nonazotemic cirrhosis. A randomized comparative study of efficacy and safety. J Hepatol. 2003; 39 (2): 187–92. DOI: 10.1016/S0168–8278(03)00188–0.

10. Pirogova I. Yu., Yakovleva S. V., Neuimina T.V. et al. The effect of ursosan on liver steatosis and fibrosis, as well as indicators of the metabolic syndrome in patients with non-alcoholic fatty liver disease: a comparative study SPHERE. Gastroenterology. Supplement to Consilium Medicum. 2018; 1: 7–14.

11. Butterworth R. F., McPhail M.J. W. L-Ornithine L-Aspartate (LOLA) for Hepatic Encephalopathy in Cirrhosis: Results of Randomized Controlled Trials and Meta-Analyses. Drugs. 2019 Feb; 79 (Suppl 1): 31–7. DOI: 10.1007/s40265–018–1024–1.

12. Canbay A., Sowa J-P. L-Ornithine L-Aspartate (LOLA) as a Novel Approach for Therapy of Non-alcoholic Fatty Liver Disease. Drugs. 2019 Feb; 79 (Suppl 1): 39–44. DOI: 10.1007/s40265–018–1020–5.

13. Zullo A., Hassan L., Lorenzetti R., Campo M. P.S., Riggio O. Rifaximin therapy and hepatic encephalopathy: Pros and cons. World J Gastrointest Pharmacol Ther. 2012. Aug 6; 3 (4): 62–7. DOI: 10.4292/wjgpt.v3.14.62.

14. Kim S. G., Kim T. Y., Sohn J. H., Um S. H., Seo Y. S., Baik S. K., et al. A randomized, multi-center, open-label study to evaluate the efficacy of carvedilol vs. propranolol to reduce portal pressure in patients with liver cirrhosis. Am J Gastroenterol. 2016; 111 (11): 1582–90. DOI: 10.1038/ajg.2016.327. Epub 2016 Aug 30.

15. Varakanahalli S., Sharma B. C.. Srivastava S., Sachdeva S., Dahale A. S. Secondary prophylaxis of hepatic encephalopathy in cirrhosis of liver: a double-blind randomized controlled trial of L-ornithine L-aspartate versus placebo. Eur J Gastroenterol Hepatol. 2018; 30 (8): 951–8. DOI: 10.1097/MEG.0000000000001137.

16. Caraceni P., Riggio O. Angeli P., Alessandria C., Neri S., Foschi F. G., et al. Long-term albumin administration in decompensated cirrhosis (ANSWER): An open-label randomised trial The Lancet. 2018; 391 (10138): 2417–29. DOI: 10.1016/S0140–6736(18)30840–7.

17. Shertsinger A. G., Zhao A. V., Ivashkin V. T., Maevskaya M. V. et al. Treatment of bleedings from varicose veins of the esophagus and stomach. Annals of HPB surgery. 2013. Т. 18 (3): 110-129.

18. Puente A., Hernandez-Gea V., Graupera I., Roque M., Colomo A., Poca M., et al. Drugs plus ligation to prevent rebleeding in cirrhosis: An updated systematic review. Liver Int. 2014; 34 (6): 823–33. DOI: 10.1111/liv.12452.