《2023年美国肝病学会实践指南:肝硬化门静脉高压和静脉曲张的风险分层及管理》摘译

An excerpt of AASLD practice guidance on risk stratification and management of portal hypertension and varices in cirrhosis(2023)

本实践指南旨在整合最佳实践建议,用于在慢性肝病患者中识别门静脉高压、预防首次肝功能失代偿、管理急性静脉曲张出血以及降低静脉曲张再出血的风险。该指南中最重要的变化涉及承认代偿期进展性慢性肝病的概念,使用无创评估识别临床有意义的门静脉高压,在发现门静脉高压时建议尽早使用非选择性β-受体阻滞剂,进一步探讨门静脉高压的潜在未来药物治疗选择,阐明优先经颈静脉肝内门体静脉分流术在急性静脉曲张出血中的作用,以及讨论胃底静脉曲张治疗相关的最新数据,并提出了新的主题,如门静脉高压性胃病、经食管超声心动图和抗肿瘤治疗前的内窥镜检查。

This Practice Guidance intends to coalesce best practice recommendations for the identification of portal hypertension(PH),for prevention of initial hepatic decompensation,for the management of acute variceal hemorrhage(AVH),and for reduction of the risk of recurrent variceal hemorrhage in chronic liver disease.The most significant changes in the current Guidance relate to recognition of the concept of compensated advanced chronic liver disease,codification of methodology to use noninvasive assessments to identify clinically significant PH(CSPH),and endorsement of a change in paradigm with the recommendation of early utilization of nonselective beta-blocker therapy when CSPH is identified.The updated guidance further explores potential future pharmacotherapy options for PH,clarifies the role of preemptive transjugular intrahepatic portosystemic shunt in AVH,discusses more recent data related to the management of cardiofundal varices,and addresses new topics such as portal hypertensive gastropathy and endoscopy prior to transesophageal echocardiography and antineoplastic therapy.