title: Evidence-based clinical practice guidelines for liver cirrhosis 2015.
abstract: The Japanese Society of Gastroenterology revised the evidence-based clinical practice guidelines for liver cirrhosis in 2015. Eighty-three clinical questions were selected, and a literature search was performed for the clinical questions with use of the MEDLINE, Cochrane, and Igaku Chuo Zasshi databases for the period between 1983 and June 2012. Manual searching of the latest important literature was added until August 2015. The guidelines were developed with use of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. This digest version in English introduces selected clinical questions and statements related to the management of liver cirrhosis and its complications. Branched-chain amino acids relieve hypoalbuminemia and hepatic encephalopathy and improve quality of life. Nucleoside analogues and peginterferon plus ribavirin combination therapy improve the prognosis of patients with hepatitis B virus related liver cirrhosis and hepatitis C related compensated liver cirrhosis, respectively, although the latter therapy may be replaced by direct-acting antivirals. For liver cirrhosis caused by primary biliary cirrhosis and active autoimmune hepatitis, urosodeoxycholic acid and steroid are recommended, respectively. The most adequate modalities for the management of variceal bleeding are the endoscopic injection sclerotherapy for esophageal varices and the balloon-occluded retrograde transvenous obliteration following endoscopic obturation with cyanoacrylate for gastric varices. Beta-blockers are useful for primary prophylaxis of esophageal variceal bleeding. The V2 receptor antagonist tolvaptan is a useful add-on therapy in careful diuretic therapy for ascites. Albumin infusion is useful for the prevention of paracentesis-induced circulatory disturbance and renal failure. In addition to disaccharides, the nonabsorbable antibiotic rifaximin is useful for the management of encephalopathy. Anticoagulation therapy is proposed for patients with acute-onset or progressive portal vein thrombosis.
authors.affiliation: Department of Gastroenterology, Endocrinology and Metabolism, Nara Medical University, 840 Shijo-cho, Kashihara-shi, Nara, 634-8522, Japan. hfukui@naramed-u.ac.jp.|Guidelines Committee for creating and evaluating the ''Evidence-based clinical practice guidelines for liver cirrhosis'', Japanese Society of Gastroenterology (JSGE), K-18 Building 8F, 8-9-13, Ginza, Chuo, Tokyo, 104-0061, Japan. hfukui@naramed-u.ac.jp.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Fukui
authors.affiliation: Guidelines Committee for creating and evaluating the ''Evidence-based clinical practice guidelines for liver cirrhosis'', Japanese Society of Gastroenterology (JSGE), K-18 Building 8F, 8-9-13, Ginza, Chuo, Tokyo, 104-0061, Japan.
authors.forename: Hidetsugu
authors.initials: H
authors.lastname: Saito
authors.affiliation: Guidelines Committee for creating and evaluating the ''Evidence-based clinical practice guidelines for liver cirrhosis'', Japanese Society of Gastroenterology (JSGE), K-18 Building 8F, 8-9-13, Ginza, Chuo, Tokyo, 104-0061, Japan.
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Ueno
authors.affiliation: Guidelines Committee for creating and evaluating the ''Evidence-based clinical practice guidelines for liver cirrhosis'', Japanese Society of Gastroenterology (JSGE), K-18 Building 8F, 8-9-13, Ginza, Chuo, Tokyo, 104-0061, Japan.
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Uto
authors.affiliation: Guidelines Committee for creating and evaluating the ''Evidence-based clinical practice guidelines for liver cirrhosis'', Japanese Society of Gastroenterology (JSGE), K-18 Building 8F, 8-9-13, Ginza, Chuo, Tokyo, 104-0061, Japan.
authors.forename: Katsutoshi
authors.initials: K
authors.lastname: Obara
authors.affiliation: Guidelines Committee for creating and evaluating the ''Evidence-based clinical practice guidelines for liver cirrhosis'', Japanese Society of Gastroenterology (JSGE), K-18 Building 8F, 8-9-13, Ginza, Chuo, Tokyo, 104-0061, Japan.
authors.forename: Isao
authors.initials: I
authors.lastname: Sakaida
authors.affiliation: Guidelines Committee for creating and evaluating the ''Evidence-based clinical practice guidelines for liver cirrhosis'', Japanese Society of Gastroenterology (JSGE), K-18 Building 8F, 8-9-13, Ginza, Chuo, Tokyo, 104-0061, Japan.
authors.forename: Akitaka
authors.initials: A
authors.lastname: Shibuya
authors.affiliation: Guidelines Committee for creating and evaluating the ''Evidence-based clinical practice guidelines for liver cirrhosis'', Japanese Society of Gastroenterology (JSGE), K-18 Building 8F, 8-9-13, Ginza, Chuo, Tokyo, 104-0061, Japan.
authors.forename: Masataka
authors.initials: M
authors.lastname: Seike
authors.affiliation: Guidelines Committee for creating and evaluating the ''Evidence-based clinical practice guidelines for liver cirrhosis'', Japanese Society of Gastroenterology (JSGE), K-18 Building 8F, 8-9-13, Ginza, Chuo, Tokyo, 104-0061, Japan.
authors.forename: Sumiko
authors.initials: S
authors.lastname: Nagoshi
authors.affiliation: Guidelines Committee for creating and evaluating the ''Evidence-based clinical practice guidelines for liver cirrhosis'', Japanese Society of Gastroenterology (JSGE), K-18 Building 8F, 8-9-13, Ginza, Chuo, Tokyo, 104-0061, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Segawa
authors.affiliation: Guidelines Committee for creating and evaluating the ''Evidence-based clinical practice guidelines for liver cirrhosis'', Japanese Society of Gastroenterology (JSGE), K-18 Building 8F, 8-9-13, Ginza, Chuo, Tokyo, 104-0061, Japan.
authors.forename: Hirohito
authors.initials: H
authors.lastname: Tsubouchi
authors.affiliation: Guidelines Committee for creating and evaluating the ''Evidence-based clinical practice guidelines for liver cirrhosis'', Japanese Society of Gastroenterology (JSGE), K-18 Building 8F, 8-9-13, Ginza, Chuo, Tokyo, 104-0061, Japan.
authors.forename: Hisataka
authors.initials: H
authors.lastname: Moriwaki
authors.affiliation: Guidelines Committee for creating and evaluating the ''Evidence-based clinical practice guidelines for liver cirrhosis'', Japanese Society of Gastroenterology (JSGE), K-18 Building 8F, 8-9-13, Ginza, Chuo, Tokyo, 104-0061, Japan.
authors.forename: Akinobu
authors.initials: A
authors.lastname: Kato
authors.affiliation: Guidelines Committee for creating and evaluating the ''Evidence-based clinical practice guidelines for liver cirrhosis'', Japanese Society of Gastroenterology (JSGE), K-18 Building 8F, 8-9-13, Ginza, Chuo, Tokyo, 104-0061, Japan.
authors.forename: Etsuko
authors.initials: E
authors.lastname: Hashimoto
authors.affiliation: Guidelines Committee for creating and evaluating the ''Evidence-based clinical practice guidelines for liver cirrhosis'', Japanese Society of Gastroenterology (JSGE), K-18 Building 8F, 8-9-13, Ginza, Chuo, Tokyo, 104-0061, Japan.
authors.forename: Kojiro
authors.initials: K
authors.lastname: Michitaka
authors.affiliation: Guidelines Committee for creating and evaluating the ''Evidence-based clinical practice guidelines for liver cirrhosis'', Japanese Society of Gastroenterology (JSGE), K-18 Building 8F, 8-9-13, Ginza, Chuo, Tokyo, 104-0061, Japan.
authors.forename: Toshikazu
authors.initials: T
authors.lastname: Murawaki
authors.affiliation: Guidelines Committee for creating and evaluating the ''Evidence-based clinical practice guidelines for liver cirrhosis'', Japanese Society of Gastroenterology (JSGE), K-18 Building 8F, 8-9-13, Ginza, Chuo, Tokyo, 104-0061, Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Sugano
authors.affiliation: Guidelines Committee for creating and evaluating the ''Evidence-based clinical practice guidelines for liver cirrhosis'', Japanese Society of Gastroenterology (JSGE), K-18 Building 8F, 8-9-13, Ginza, Chuo, Tokyo, 104-0061, Japan.
authors.forename: Mamoru
authors.initials: M
authors.lastname: Watanabe
authors.affiliation: Guidelines Committee for creating and evaluating the ''Evidence-based clinical practice guidelines for liver cirrhosis'', Japanese Society of Gastroenterology (JSGE), K-18 Building 8F, 8-9-13, Ginza, Chuo, Tokyo, 104-0061, Japan.
authors.forename: Tooru
authors.initials: T
authors.lastname: Shimosegawa
mesh_terms: D055317:Evidence-Based Practice; D006801:Humans; D008103:Liver Cirrhosis / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D017410:Practice Guidelines as Topic
keywords: Antiviral therapy; Ascites; Diagnosis; Gastroesophageal varices; Hepatic encephalopathy; Hepatorenal syndrome; Liver cirrhosis; Liver transplant; Nonviral cirrhosis; Nutritional therapy