EASL presents clinical guidelines for HBV, ALD, ALF, PBC, PSC

AMSTERDAM — At this year’s International Liver Congress, EASL presented new clinical practice guidelines for the diagnosis, management and treatment of hepatitis B, primary biliary cholangitis, primary sclerosing cholangitis, alcoholic liver disease and acute liver failure.

Healio.com/Hepatology presents a brief overview of each of these guidelines.

Guideline for the management of HBV

“Hepatitis B virus infections are major health threats that affect about 240 million individuals worldwide,” Frank Tacke, MD, PhD, member of the Clinical Practice Guidelines panel and EASL governing board member, said in a press release from the congress. “The updated EASL guidelines integrate the latest scientific advances on diagnosis and therapy of hepatitis B, thereby providing clear guidance to clinicians and patients for the management of this potentially life-threatening disease.”

The guideline redefines the assessment of HBV into five phases; advises on the two main treatment methods, nucleos(t)ide analog therapy and pegylated IFN; discusses special patients groups, such as children, health care workers, pregnant women and patients with viral coinfections; and provides recommendations for future treatment options. Read more

Guideline for the diagnosis and management of PBC

“The EASL Primary Biliary Cholangitis guidelines are meant to support clinicians in establishing a long-term commitment with patients and their disease, providing indications on how to stratify the risk from diagnosis to disease progression. The guidelines will also help identify which patients require second-line treatment, in which advances are fortunately being made,” Marco Marzioni, MD, professor of gastroenterology, Università Politecnica delle Marche, University Hospital of Ancona, Italy, said in a press release.

The guideline defines the diagnosis of PBC and the stratification of risk factors; clarifies the roles of ursodeoxycholic acid and Ocaliva (obeticholic acid, Intercept Pharmaceuticals) in treatment; and provides recommendations for the management of symptoms and complications of PBC, such as pruritus, sicca complex and fatigue. Read more

Guideline on the role of endoscopy in PSC

“The diagnosis of PSC is based on the combination of clinical, laboratory, imaging and histological findings,” the researchers wrote. “Briefly, a diagnostic work-up for PSC should be performed in all patients with inflammatory bowel disease (IBD) and abnormal liver biochemistry test findings, especially elevated alkaline phosphatase (ALP) and gamma glutamyl transferase (GGT) values, as well as in non-IBD patients with elevated cholestatic liver enzymes not otherwise explained.”

The guideline discusses diagnosis and surveillance of PSC; the use of endoscopic retrograde cholangiopancreatography (ERCP) in established PSC, as well as the potential superiority of magnetic resonance cholangiography (MRC); treatment with stenting and balloon dilation; and provides recommendations related to endoscopic surveillance of PSC-associated IBD. Read more

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Guideline for the management of alcoholic liver disease

“ALD is a complex disease, the successful management of which hinges on the integration of all the competences in public health, epidemiology, addiction behavior and alcohol-induced organ injury,” the researchers wrote. “Both primary intervention to reduce alcohol-associated morbidity and mortality rely on the coordinated action of multidisciplinary teams established at local, national and international levels.”

The guideline advises on the difficult diagnosis of often-asymptomatic ALD; discusses the range of risk factors related to disease progression; advises on the burden and management of ALD; and provides recommendations for future studies, such as noninvasive tools for diagnosis and further study on the role of s-adenosyl methionine in alcoholic cirrhosis. Read more

Guideline for the management of acute liver failure

“ALF is frequently, but often incorrectly used to describe both acute deterioration in liver function in patients with chronic liver disease (a condition that should be termed acute-on-chronic liver failure [AoCLF]), or liver involvement in systemic disease processes. Liver injury secondary to alcohol, which presents as alcoholic hepatitis, and other forms of AoCLF, can be difficult to distinguish from ALF on occasion,” the researchers wrote. “However, there are clear differences, and different forms of management are required.”

The guideline reviews the clinical features of ALF; provides measures for assessment and management at presentation; provides recommendations for organ-specific management; discusses artificial and bioartificial liver devices and their use in therapy; and provides an overview of the ethical complications related to liver transplantation as well as transplantation outcomes. Read more