Review article: current and emerging therapies for the management of cirrhosis and its complications

Abstract

Background Cirrhosis is increasingly common and morbid. Optimal utilisation of therapeutic strategies to prevent and control the complications of cirrhosis are central to improving clinical and patient‐reported outcomes. Methods We conducted a narrative review of the literature focusing on the most recent advances. Results We review the aetiology‐focused therapies that can prevent cirrhosis and its complications. These include anti‐viral therapies, psychopharmacological therapy for alcohol‐use disorder, and the current landscape of clinical trials for non‐alcoholic steatohepatitis. We review the current standard of care and latest developments in the management of hepatic encephalopathy (HE), ascites and hepatorenal syndrome. We evaluate the promise and drawbacks of chemopreventative therapies that have been examined in trials and observational studies which may reduce the risk of hepatocellular carcinoma and cirrhosis complications. Finally, we examine the therapies which address the non‐pain symptoms of cirrhosis including pruritis, muscle cramps, sexual dysfunction and fatigue. Conclusion The improvement of clinical and patient‐reported outcomes for patients with cirrhosis is possible by applying evidence‐based pharmacotherapeutic approaches to the prevention and treatment of cirrhosis complications.

Real‐world clinical features, health‐care utilization, and economic burden in decompensated cirrhosis patients: A national database

“…Liver cirrhosis (LC), the final stage of chronic liver diseases with progressive liver fibrosis, is known to originate from various etiologies, including chronic hepatitis B virus (HBV) or hepatitis C virus (HCV) infection, alcoholic liver disease, non-alcoholic fatty liver disease (NAFLD), autoimmune liver disease, and metabolism-related genetic disorders. 1,2 Disease progression to LC presents a serious public health burden on the health-care system, despite considerable advances in therapy and care. [3][4][5] First, LC itself could substantially increase the risk of morbidity and mortality.…”

Palliative Care for Patients with End-Stage Liver Disease

“…Another important aspect is to avoid using diuretics at night and use of melatonin which has been shown to improve quality of sleep in primary and secondary insomnia in well conducted metanalyses of mostly non-cirrhosis patients. 40 Sexual dysfunction occurs in more than 50% of patients with cirrhosis and occurring in up to 93% in those with advanced cirrhosis.…”

Editorial: Percutaneous placement of a permanent tunnelled catheter for patients with non‐malignant ascites—Is it safe?

“…Ascites is a frequent complication of cirrhosis and is associated with a mortality rate above 20%. 1,2 The condition may become diureticresistant, or patients may be unable to tolerate an effective diuretic dosage. 3 This can result in refractory ascites that has a major impact on quality of life.…”