Austrian consensus on the diagnosis and management of portal hypertension in advanced chronic liver disease (Billroth IV)

Abstract

SummaryThe Billroth IV consensus was developed during a consensus meeting of the Austrian Society of Gastroenterology and Hepatology (ÖGGH) and the Austrian Society of Interventional Radiology (ÖGIR) held on the 26th of November 2022 in Vienna.Based on international recommendations and considering recent landmark studies, the Billroth IV consensus provides guidance regarding the diagnosis and management of portal hypertension in advanced chronic liver disease.

Inhibition of the renal apical sodium dependent bile acid transporter prevents cholemic nephropathy in mice with obstructive cholestasis

“…The present human data does not exclude that bilirubin (and possibly additional cholephiles released from the liver) may be relevant, considering that patients were selected based on a cut-off of >6 mg bilirubin/dl. The latter was chosen as it denotes liver dysfunction in the context of decompensated cirrhosis 4 and an analysis of 1,372 patients included in the above-mentioned registry study found that profound elevations of BA are uncommon in patients with lower bilirubin values (data not shown). Notably, mean arterial pressure (as a marker of circulatory dysfunction) was not included in our models, as all bar two patients with mean arterial pressures of 64 mmHg had pressures ≥65 mmHg and C-reactive protein (as a marker of systemic inflammation) was less closely associated with proximal TEC injury than sum BA concentration.…”

“…Acute kidney injury (AKI) is a frequent complication in patients with liver disease that leads to high morbidity and mortality 1 , 2 and has several causes, particularly hemodynamic changes, and infections. 1 , 3 However, an underestimated and increasingly acknowledged 4 , 5 cause of AKI in liver diseases is cholemic nephropathy (CN), 2 , 6 , 7 which describes renal dysfunction together with characteristic renal histological features such as tubular cell injury and Hall’s stain-positive bilirubin casts. It has long been known that the risk of AKI is increased in jaundiced patients.…”

Attitudes towards transjugular intrahepatic portosystemic shunt (TIPS) in Australia: a national survey of TIPS centres

“…Open access technology, and the expanding list of indications. [15][16][17][18][19][20][21] However, there remains an absence of up-to-date Australian guidance on TIPS referral pathways and practice guidelines. As a result, it is unclear whether current practices across institutions are in line with international standards.…”

“…Over recent years, clinical practice guidelines have increasingly recognised advances related to procedural techniques, TIPS stent technology, and the expanding list of indications 15–21. However, there remains an absence of up-to-date Australian guidance on TIPS referral pathways and practice guidelines.…”

Lower free triiodothyronine (fT3) levels in cirrhosis are linked to systemic inflammation, higher risk of acute-on-chronic liver failure, and mortality

“… 1 , 2 In early asymptomatic stages, ACLD is considered compensated. With the development of portal hypertension (PH)-related complications, including ascites, hepatic encephalopathy (HE), and variceal bleeding, patients progress to decompensated ACLD (dACLD), [3] , [4] , [5] which is associated with a considerably worse prognosis. 6 , 7 Acute-on-chronic liver failure (ACLF), defined by hepatic and/or extrahepatic organ failure(s), 8 , 9 may occur in patients with dACLD 6 , 10 and is closely associated with systemic inflammation.…”