Dtsch Med Wochenschr 2021; 146(10): 684-697
DOI: 10.1055/a-1218-9159
CME-Fortbildung

Leberzirrhose

Cirrhosis
Alexander Zipprich
,
Cristina Ripoll

Leberzirrhose und ihre Komplikationen – in diesem Übersichtsartikel wird der aktuelle Stand der Therapieoptionen von Komplikationen der Leberzirrhose zusammengefasst. Besonderes Augenmerk wird hierbei auf die Ösophagusvarizenblutung, den Aszites und das Nierenversagen als schwerwiegende Komplikationen gelegt.

Abstract

The review summarizes the management and therapy of cirrhosis. Special focus is made on the complications of cirrhosis, like variceal bleeding, ascites, renal failure and hepatic encephalopathy.



Publication History

Article published online:
06 May 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 
  • Literatur

  • 1 Zipprich A, Garcia-Tsao G, Rogowski S. et al. Prognostic indicators of survival in patients with compensated and decompensated cirrhosis. Liver Int 2012; 32: 1407-1414
  • 2 D’Amico G, Pasta L, Morabito A. et al. Competing risks and prognostic stages of cirrhosis: a 25-year inception cohort study of 494 patients. Aliment Pharmacol Ther 2014; 39: 1180-1193
  • 3 Moreau R, Jalan R, Gines P. et al Acute-on-chronic liver failure is a distinct syndrome that develops in patients with acute decompensation of cirrhosis. Gastroenterology 2013; 144: 1426-1437 , 1437.e1-9
  • 4 Trebicka J, Fernandez J, Papp M. et al. The PREDICT study uncovers three clinical courses of acutely decompensated cirrhosis that have distinct pathophysiology. J Hepatol 2020; 73: 842-854
  • 5 Bernardi M, Moreau R, Angeli P. et al. Mechanisms of decompensation and organ failure in cirrhosis: From peripheral arterial vasodilation to systemic inflammation hypothesis. J Hepatol 2015; 63: 1272-1284
  • 6 Gotz M, Anders M, Biecker E. et al. [S2k Guideline Gastrointestinal Bleeding – Guideline of the German Society of Gastroenterology DGVS]. Z Gastroenterol 2017; 55: 883-936
  • 7 Groszmann RJ, Garcia-Tsao G, Bosch J. et al. Beta-blockers to prevent gastroesophageal varices in patients with cirrhosis. N Engl J Med 2005; 353: 2254-2261
  • 8 Zacharias AP, Jeyaraj R, Hobolth L. et al. Carvedilol versus traditional, non-selective beta-blockers for adults with cirrhosis and gastroesophageal varices. Cochrane Database Syst Rev 2018; 10: CD011510
  • 9 Hernandez-Gea V, Aracil C, Colomo A. et al. Development of ascites in compensated cirrhosis with severe portal hypertension treated with beta-blockers. Am J Gastroenterol 2012; 107: 418-427
  • 10 de Franchis R, Baveno VIF. Expanding consensus in portal hypertension: Report of the Baveno VI Consensus Workshop: Stratifying risk and individualizing care for portal hypertension. J Hepatol 2015; 63: 743-752
  • 11 Seo YS, Park SY, Kim MY. et al. Lack of difference among terlipressin, somatostatin, and octreotide in the control of acute gastroesophageal variceal hemorrhage. Hepatology 2014; 60: 954-963
  • 12 Garcia-Pagan JC, Caca K, Bureau C. et al. Early use of TIPS in patients with cirrhosis and variceal bleeding. N Engl J Med 2010; 362: 2370-2379
  • 13 Sauerbruch T, Mengel M, Dollinger M. et al. Prevention of Rebleeding From Esophageal Varices in Patients With Cirrhosis Receiving Small-Diameter Stents Versus Hemodynamically Controlled Medical Therapy. Gastroenterology 2015; 149: 660-668.e1
  • 14 Gerbes AL, Labenz J, Appenrodt B. et al. [Updated S2k-Guideline „Complications of liver cirrhosis“. German Society of Gastroenterology (DGVS)]. Z Gastroenterol 2019; 57: e168
  • 15 Salerno F, Camma C, Enea M. et al. Transjugular intrahepatic portosystemic shunt for refractory ascites: a meta-analysis of individual patient data. Gastroenterology 2007; 133: 825-834
  • 16 Bureau C, Thabut D, Oberti F. et al. Transjugular Intrahepatic Portosystemic Shunts With Covered Stents Increase Transplant-Free Survival of Patients With Cirrhosis and Recurrent Ascites. Gastroenterology 2017; 152: 157-163
  • 17 Martin-Llahi M, Guevara M, Torre A. et al. Prognostic importance of the cause of renal failure in patients with cirrhosis. Gastroenterology 2011; 140: 488-496.e484
  • 18 European Association for the Study of the Liver. EASL Clinical Practice Guidelines for the management of patients with decompensated cirrhosis. J Hepatol 2018; 69: 406-460
  • 19 Cavallin M, Piano S, Romano A. et al. Terlipressin given by continuous intravenous infusion versus intravenous boluses in the treatment of hepatorenal syndrome: A randomized controlled study. Hepatology 2016; 63: 983-992
  • 20 Gifford FJ, Morling JR, Fallowfield JA. Systematic review with meta-analysis: vasoactive drugs for the treatment of hepatorenal syndrome type 1. Aliment Pharmacol Ther 2017; 45: 593-603