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British Society of Gastroenterology Best Practice Guidance: outpatient management of cirrhosis - part 2: decompensated cirrhosis

Lookup NU author(s): Dr Dina Mansour, Dr Steven MassonORCiD, Professor Stuart McPhersonORCiD



This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0).


© 2023 BMJ Publishing Group. All rights reserved.There are two distinct phases in the natural history of cirrhosis: compensated disease (corresponding to Child Pugh A and early Child Pugh B disease), where the patient may be largely asymptomatic, progressing with increasing portal hypertension and liver dysfunction to decompensated disease (corresponding to Child Pugh late B-C), characterised by the development of overt clinical signs, including jaundice, hepatic encephalopathy (HE), ascites, renal dysfunction and variceal bleeding. The transition from compensated cirrhosis to decompensated cirrhosis (DC) heralds a watershed in the nature and prognosis of the disease. DC is a systemic disease, characterised by multiorgan/system dysfunction, including haemodynamic and immune dysfunction. In this second part of our three-part series on the outpatient management of cirrhosis, we address outpatient management of DC, including management of varices, ascites, HE, nutrition, liver transplantation and palliative care. We also introduce an outpatient DC care bundle. For recommendations on screening for osteoporosis, hepatocellular carcinoma surveillance and vaccination see part one of the guidance. Part 3 of the guidance focusses on special circumstances encountered in patients with cirrhosis, including surgery, pregnancy, travel, management of bleeding risk for invasive procedures and portal vein thrombosis.

Publication metadata

Author(s): Mansour D, Masson S, Corless L, Douds AC, Shawcross DL, Johnson J, Leithead JA, Heneghan MA, Rahim MN, Tripathi D, Ross V, Hammond J, Grapes A, Hollywood C, Botterill G, Bonner E, Donnelly M, McPherson S, West R

Publication type: Article

Publication status: Published

Journal: Frontline Gastroenterology

Year: 2023

Volume: 14

Issue: 6

Pages: 462-473

Online publication date: 10/10/2023

Acceptance date: 02/04/2018

Date deposited: 22/02/2024

ISSN (print): 2041-4137

ISSN (electronic): 2041-4145

Publisher: BMJ Publishing Group


DOI: 10.1136/flgastro-2023-102431


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