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Erschienen in: Gastro-News 4/2020

28.08.2020 | Leberzirrhose | Fortbildung_CME

Hepatologie - Teil 4: Leberzirrhose

Aktualisierte Leitlinie "Komplikationen der Leberzirrhose" - Was hat sich verändert?

verfasst von: PD Dr. med. Henning W. Zimmermann, Prof. Dr. med. Tony Bruns

Erschienen in: Gastro-News | Ausgabe 4/2020

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Auszug

Bei der Entstehung der Leberfibrose stimulieren chronische inflammatorische und immunologische Prozesse die Fibrogenese, sodass es zu einer Architekturstörung und einem Funktionsverlust der Leber kommt. Im Stadium der Zirrhose führt dies zu kontinuierlich zunehmenden Funktionseinschränkungen und Komplikationen, die mit einem hohen Letalitätsrisiko assoziiert sind. Das rechtzeitige Erkennen von Komplikationen und deren Therapie ist daher für die Prognose der Patienten wesentlich.
Literatur
1.
Zurück zum Zitat Gerbes AL, Labenz J, Appenrodt B, Dollinger M, Gundling F, Gülberg V, et al. Aktualisierte S2k-Leitlinie der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) "Komplikationen der Leberzirrhose". Z Für Gastroenterol 2019;57:611-80 Gerbes AL, Labenz J, Appenrodt B, Dollinger M, Gundling F, Gülberg V, et al. Aktualisierte S2k-Leitlinie der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) "Komplikationen der Leberzirrhose". Z Für Gastroenterol 2019;57:611-80
2.
Zurück zum Zitat Götz M, Anders M, Biecker E, Bojarski C, Braun G, Brechmann T, et al. S2k-Leitlinie Gastrointestinale Blutung. Z Für Gastroenterol 2017;55:883-936 Götz M, Anders M, Biecker E, Bojarski C, Braun G, Brechmann T, et al. S2k-Leitlinie Gastrointestinale Blutung. Z Für Gastroenterol 2017;55:883-936
3.
Zurück zum Zitat Kim JJ, Tsukamoto MM, Mathur AK, Ghomri YM, Hou LA, Sheibani S, et al. Delayed Paracentesis Is Associated With Increased In-Hospital Mortality in Patients With Spontaneous Bacterial Peritonitis. Am J Gastroenterol 2014;109:1436-42 Kim JJ, Tsukamoto MM, Mathur AK, Ghomri YM, Hou LA, Sheibani S, et al. Delayed Paracentesis Is Associated With Increased In-Hospital Mortality in Patients With Spontaneous Bacterial Peritonitis. Am J Gastroenterol 2014;109:1436-42
4.
Zurück zum Zitat Rosenblatt R, Tafesh Z, Shen N, Cohen-Mekelburg S, Kumar S, Lucero C, et al. Early Paracentesis in High-Risk Hospitalized Patients: Time for a New Quality Indicator. Am J Gastroenterol 2019;114:1863-9 Rosenblatt R, Tafesh Z, Shen N, Cohen-Mekelburg S, Kumar S, Lucero C, et al. Early Paracentesis in High-Risk Hospitalized Patients: Time for a New Quality Indicator. Am J Gastroenterol 2019;114:1863-9
5.
Zurück zum Zitat Singh V, Dhungana SP, Singh B, Vijayverghia R, Nain CK, Sharma N, et al. Midodrine in patients with cirrhosis and refractory or recurrent ascites: a randomized pilot study. J Hepatol 2012;56:348-54 Singh V, Dhungana SP, Singh B, Vijayverghia R, Nain CK, Sharma N, et al. Midodrine in patients with cirrhosis and refractory or recurrent ascites: a randomized pilot study. J Hepatol 2012;56:348-54
6.
Zurück zum Zitat Singh V, Singh A, Singh B, Vijayvergiya R, Sharma N, Ghai A, et al. Midodrine and clonidine in patients with cirrhosis and refractory or recurrent ascites: a randomized pilot study. Am J Gastroenterol 2013;108:560-7 Singh V, Singh A, Singh B, Vijayvergiya R, Sharma N, Ghai A, et al. Midodrine and clonidine in patients with cirrhosis and refractory or recurrent ascites: a randomized pilot study. Am J Gastroenterol 2013;108:560-7
7.
Zurück zum Zitat Solà E, Solé C, Simón-Talero M, Martín-Llahí M, Castellote J, Garcia-Martínez R, et al. Midodrine and albumin for prevention of complications in patients with cirrhosis awaiting liver transplantation. A randomized placebo-controlled trial. J Hepatol 2018;69:1250-9 Solà E, Solé C, Simón-Talero M, Martín-Llahí M, Castellote J, Garcia-Martínez R, et al. Midodrine and albumin for prevention of complications in patients with cirrhosis awaiting liver transplantation. A randomized placebo-controlled trial. J Hepatol 2018;69:1250-9
8.
Zurück zum Zitat Sersté T, Melot C, Francoz C, Durand F, Rautou P-E, Valla D, et al. Deleterious effects of beta-blockers on survival in patients with cirrhosis and refractory ascites. Hepatol Baltim Md 2010;52:1017-22 Sersté T, Melot C, Francoz C, Durand F, Rautou P-E, Valla D, et al. Deleterious effects of beta-blockers on survival in patients with cirrhosis and refractory ascites. Hepatol Baltim Md 2010;52:1017-22
9.
Zurück zum Zitat Mandorfer M, Bota S, Schwabl P, Bucsics T, Pfisterer N, Kruzik M, et al. Nonselective β blockers increase risk for hepatorenal syndrome and death in patients with cirrhosis and spontaneous bacterial peritonitis. Gastroenterology 2014;146:1680-1690.e1 Mandorfer M, Bota S, Schwabl P, Bucsics T, Pfisterer N, Kruzik M, et al. Nonselective β blockers increase risk for hepatorenal syndrome and death in patients with cirrhosis and spontaneous bacterial peritonitis. Gastroenterology 2014;146:1680-1690.e1
10.
Zurück zum Zitat Leithead JA, Rajoriya N, Tehami N, Hodson J, Gunson BK, Tripathi D, et al. Non-selective β-blockers are associated with improved survival in patients with ascites listed for liver transplantation. Gut 2015;64:1111-9 Leithead JA, Rajoriya N, Tehami N, Hodson J, Gunson BK, Tripathi D, et al. Non-selective β-blockers are associated with improved survival in patients with ascites listed for liver transplantation. Gut 2015;64:1111-9
11.
Zurück zum Zitat Bhutta AQ, Garcia-Tsao G, Reddy KR, Tandon P, Wong F, O'Leary JG, et al. Beta-blockers in hospitalised patients with cirrhosis and ascites: mortality and factors determining discontinuation and reinitiation. Aliment Pharmacol Ther 2018;47:78-85 Bhutta AQ, Garcia-Tsao G, Reddy KR, Tandon P, Wong F, O'Leary JG, et al. Beta-blockers in hospitalised patients with cirrhosis and ascites: mortality and factors determining discontinuation and reinitiation. Aliment Pharmacol Ther 2018;47:78-85
12.
Zurück zum Zitat Mookerjee RP, Pavesi M, Thomsen KL, Mehta G, Macnaughtan J, Bendtsen F, et al. Treatment with non-selective beta blockers is associated with reduced severity of systemic inflammation and improved survival of patients with acute-on-chronic liver failure. J Hepatol 2016;64:574-82 Mookerjee RP, Pavesi M, Thomsen KL, Mehta G, Macnaughtan J, Bendtsen F, et al. Treatment with non-selective beta blockers is associated with reduced severity of systemic inflammation and improved survival of patients with acute-on-chronic liver failure. J Hepatol 2016;64:574-82
13.
Zurück zum Zitat Bossen L, Krag A, Vilstrup H, Watson H, Jepsen P. Nonselective β-blockers do not affect mortality in cirrhosis patients with ascites: Post Hoc analysis of three randomized controlled trials with 1198 patients. Hepatol Baltim Md 2016;63:1968-76 Bossen L, Krag A, Vilstrup H, Watson H, Jepsen P. Nonselective β-blockers do not affect mortality in cirrhosis patients with ascites: Post Hoc analysis of three randomized controlled trials with 1198 patients. Hepatol Baltim Md 2016;63:1968-76
14.
Zurück zum Zitat Tergast TL, Kimmann M, Laser H, Gerbel S, Manns MP, Cornberg M, et al. Systemic arterial blood pressure determines the therapeutic window of non-selective beta blockers in decompensated cirrhosis. Aliment Pharmacol Ther 2019;50:696-706 Tergast TL, Kimmann M, Laser H, Gerbel S, Manns MP, Cornberg M, et al. Systemic arterial blood pressure determines the therapeutic window of non-selective beta blockers in decompensated cirrhosis. Aliment Pharmacol Ther 2019;50:696-706
15.
Zurück zum Zitat Bureau C, Thabut D, Oberti F, Dharancy S, Carbonell N, Bouvier A, et al. Transjugular Intrahepatic Portosystemic Shunts With Covered Stents Increase Transplant-Free Survival of Patients With Cirrhosis and Recurrent Ascites. Gastroenterology 2017;152:157-63 Bureau C, Thabut D, Oberti F, Dharancy S, Carbonell N, Bouvier A, et al. Transjugular Intrahepatic Portosystemic Shunts With Covered Stents Increase Transplant-Free Survival of Patients With Cirrhosis and Recurrent Ascites. Gastroenterology 2017;152:157-63
16.
Zurück zum Zitat European Association for the Study of the Liver. Electronic address: easloffice@easloffice.eu, European Association for the Study of the Liver. EASL Clinical Practice Guidelines for the management of patients with decompensated cirrhosis. J Hepatol 2018;69:406-60 European Association for the Study of the Liver. Electronic address: easloffice@easloffice.eu, European Association for the Study of the Liver. EASL Clinical Practice Guidelines for the management of patients with decompensated cirrhosis. J Hepatol 2018;69:406-60
17.
Zurück zum Zitat Cavallin M, Piano S, Romano A, Fasolato S, Frigo AC, Benetti G, et al. Terlipressin given by continuous intravenous infusion versus intravenous boluses in the treatment of hepatorenal syndrome: A randomized controlled study. Hepatol Baltim Md 2016;63:983-92 Cavallin M, Piano S, Romano A, Fasolato S, Frigo AC, Benetti G, et al. Terlipressin given by continuous intravenous infusion versus intravenous boluses in the treatment of hepatorenal syndrome: A randomized controlled study. Hepatol Baltim Md 2016;63:983-92
18.
Zurück zum Zitat Vilstrup H, Amodio P, Bajaj J, Cordoba J, Ferenci P, Mullen KD, et al. Hepatic encephalopathy in chronic liver disease: 2014 Practice Guideline by the American Association for the Study of Liver Diseases and the European Association for the Study of the Liver. Hepatol Baltim Md 2014;60:715-35 Vilstrup H, Amodio P, Bajaj J, Cordoba J, Ferenci P, Mullen KD, et al. Hepatic encephalopathy in chronic liver disease: 2014 Practice Guideline by the American Association for the Study of Liver Diseases and the European Association for the Study of the Liver. Hepatol Baltim Md 2014;60:715-35
19.
Zurück zum Zitat Weissenborn K, Ennen JC, Schomerus H, Rückert N, Hecker H. Neuropsychological characterization of hepatic encephalopathy. J Hepatol 2001;34:768-73 Weissenborn K, Ennen JC, Schomerus H, Rückert N, Hecker H. Neuropsychological characterization of hepatic encephalopathy. J Hepatol 2001;34:768-73
20.
Zurück zum Zitat Kircheis G, Wettstein M, Timmermann L, Schnitzler A, Häussinger D. Critical flicker frequency for quantification of low-grade hepatic encephalopathy. Hepatol Baltim Md 2002;35:357-66 Kircheis G, Wettstein M, Timmermann L, Schnitzler A, Häussinger D. Critical flicker frequency for quantification of low-grade hepatic encephalopathy. Hepatol Baltim Md 2002;35:357-66
21.
Zurück zum Zitat Kircheis G, Hilger N, Häussinger D. Value of critical flicker frequency and psychometric hepatic encephalopathy score in diagnosis of low-grade hepatic encephalopathy. Gastroenterology 2014;146:961-9 Kircheis G, Hilger N, Häussinger D. Value of critical flicker frequency and psychometric hepatic encephalopathy score in diagnosis of low-grade hepatic encephalopathy. Gastroenterology 2014;146:961-9
22.
Zurück zum Zitat Campagna F, Montagnese S, Ridola L, Senzolo M, Schiff S, De Rui M, et al. The animal naming test: An easy tool for the assessment of hepatic encephalopathy. Hepatol Baltim Md 2017;66:198-208 Campagna F, Montagnese S, Ridola L, Senzolo M, Schiff S, De Rui M, et al. The animal naming test: An easy tool for the assessment of hepatic encephalopathy. Hepatol Baltim Md 2017;66:198-208
23.
Zurück zum Zitat Haj M, Rockey DC. Ammonia Levels Do Not Guide Clinical Management of Patients With Hepatic Encephalopathy Caused by Cirrhosis. Am J Gastroenterol 2019 Haj M, Rockey DC. Ammonia Levels Do Not Guide Clinical Management of Patients With Hepatic Encephalopathy Caused by Cirrhosis. Am J Gastroenterol 2019
24.
Zurück zum Zitat Pantham G, Post A, Venkat D, Einstadter D, Mullen KD. A New Look at Precipitants of Overt Hepatic Encephalopathy in Cirrhosis. Dig Dis Sci 2017;62:2166-73 Pantham G, Post A, Venkat D, Einstadter D, Mullen KD. A New Look at Precipitants of Overt Hepatic Encephalopathy in Cirrhosis. Dig Dis Sci 2017;62:2166-73
25.
Zurück zum Zitat Gluud LL, Vilstrup H, Morgan MY. Nonabsorbable disaccharides for hepatic encephalopathy: A systematic review and meta-analysis. Hepatol Baltim Md 2016;64:908-22 Gluud LL, Vilstrup H, Morgan MY. Nonabsorbable disaccharides for hepatic encephalopathy: A systematic review and meta-analysis. Hepatol Baltim Md 2016;64:908-22
26.
Zurück zum Zitat Sharma BC, Sharma P, Lunia MK, Srivastava S, Goyal R, Sarin SK. A randomized, double-blind, controlled trial comparing rifaximin plus lactulose with lactulose alone in treatment of overt hepatic encephalopathy. Am J Gastroenterol 2013;108:1458-63 Sharma BC, Sharma P, Lunia MK, Srivastava S, Goyal R, Sarin SK. A randomized, double-blind, controlled trial comparing rifaximin plus lactulose with lactulose alone in treatment of overt hepatic encephalopathy. Am J Gastroenterol 2013;108:1458-63
27.
Zurück zum Zitat Bass NM, Mullen KD, Sanyal A, Poordad F, Neff G, Leevy CB, et al. Rifaximin treatment in hepatic encephalopathy. N Engl J Med 2010;362:1071-81 Bass NM, Mullen KD, Sanyal A, Poordad F, Neff G, Leevy CB, et al. Rifaximin treatment in hepatic encephalopathy. N Engl J Med 2010;362:1071-81
Metadaten
Titel
Hepatologie - Teil 4: Leberzirrhose
Aktualisierte Leitlinie "Komplikationen der Leberzirrhose" - Was hat sich verändert?
verfasst von
PD Dr. med. Henning W. Zimmermann
Prof. Dr. med. Tony Bruns
Publikationsdatum
28.08.2020
Verlag
Springer Medizin
Erschienen in
Gastro-News / Ausgabe 4/2020
Print ISSN: 1869-1005
Elektronische ISSN: 2520-8667
DOI
https://doi.org/10.1007/s15036-020-1346-1

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