Preventing First and Further Decompensation in Advanced Chronic Liver Disease - PubMed
8 hours ago
- #carvedilol
- #chronic liver disease
- #decompensation prevention
- Advanced chronic liver disease (ACLD) is a major global health issue causing significant morbidity and mortality.
- Preventing hepatic decompensation, both initial and recurrent, is key to improving survival in ACLD.
- The transition from compensated (cACLD) to decompensated (dACLD) phases is influenced by clinically significant portal hypertension (CSPH) and continuous exposure to etiologic factors.
- Systemic triggers like infections, portal vein thrombosis, and hepatocellular carcinoma can precipitate decompensation.
- A multidisciplinary approach is essential for prevention, including etiologic control, hemodynamic modulation, vaccination, nutrition, physical activity, and endoscopic therapy.
- Carvedilol, a non-selective beta-blocker (NSBB), is more effective than propranolol in reducing hepatic venous pressure gradient (HVPG) and preventing first decompensation.
- In dACLD, carvedilol remains preferred over propranolol, which shows reduced efficacy.
- Endoscopic variceal ligation (EVL) is an alternative for NSBB-intolerant patients in cACLD and crucial for secondary prophylaxis.
- Combining EVL with carvedilol is being explored in Child-Pugh B/C patients for better outcomes.
- Risk stratification using non-invasive tests and revisiting antibiotic prophylaxis are important in managing ACLD.