Evidence-based clinical practice guidelines for liver cirrhosis 2020

Area of Science:

• Hepatology
• Gastroenterology
• Clinical Practice Guidelines

Background:

• The Japanese Society of Gastroenterology (JSGE) previously published guidelines for liver cirrhosis in 2010 and 2015.
• Significant advancements in understanding and treating liver cirrhosis and its complications have occurred since 2015.
• International guidelines from organizations like EASL and AASLD have also been updated, necessitating a review of current Japanese guidelines.

Purpose of the Study:

• To publish the revised third edition of the clinical practice guidelines for liver cirrhosis in 2020.
• To integrate new findings and treatments for liver cirrhosis and its complications.
• To align Japanese clinical practice with international standards while incorporating Japan-specific evidence.

Main Methods:

• A joint revision by the JSGE and the Japanese Society of Hepatology (JSH).
• Inclusion of clinical questions (CQs), background questions (BQs), and future research questions (FRQs).
• Referencing the latest international guidelines (EASL, AASLD) and recent scientific literature.

Main Results:

• The guidelines cover updated antiviral therapy for hepatitis B and C, and treatments for non-viral cirrhosis (ASH/NASH, autoimmune).
• Comprehensive updates on the diagnosis and management of liver cirrhosis complications including ascites, hepatorenal syndrome, hepatic encephalopathy, and more.
• Inclusion of prognosis prediction, liver transplantation, and nutritional therapy recommendations.

Conclusions:

• The 2020 guidelines represent a significant update, incorporating new evidence and treatments for liver cirrhosis.
• This joint guideline aims to provide comprehensive, evidence-based recommendations for daily clinical practice in Japan.
• The publication includes novel sections on BQs and FRQs to enhance basic knowledge and guide future research.