Portal hypertension and ascites are two crucial events in the natural history of liver cirrhosis, whose appearance marks a downward shift in the prognosis of the disease. Over the years, several international and national societies have issued clinical practice guidelines for the diagnosis and management of portal hypertension and ascites. The present document addresses the needs of an updated guidance on the clinical management of these conditions. Accordingly, the AISF Governing Board appointed a multi-disciplinary committee of experts for drafting an update of the most recent EASL Clinical Practice Guidelines. The aim of this work was to adapt the EASL recommendations to national regulations and resources, local circumstances and settings, infrastructure, and cost/benefit strategies to avoid duplication of efforts and optimize resource utilization. The committee defined the objectives, the key issues and retrieved the relevant evidence by performing a systematic review of the literature. Finally, the committee members (chosen on the basis of their specific expertise) identified the guidelines’ key questions and developed them following the PICO format (Population, Intervention, Comparison, Outcomes). For each of the PICO questions, the systematic review of the literature was made on the most important scientific databases (Pubmed, Scopus, Embase)
The present clinical practice guidelines (CPGs) on portal hypertension and ascites issued by the Italian Association for the Study of the Liver – (AISF) are the current update to the previous EASL CPGs [1,2]. They can be considered as a mediation between the growing amount of research findings and the actual clinical practice. EASL CPGs [1, 2] can be adapted to national regulations and resources, local circumstances and settings, infrastructure, and cost/benefit strategies to avoid duplication of efforts and optimize resource utilization. While respecting the principles of a rigorous evidence-based approach, guideline adaptation stresses the process of putting evidence into context and directs developers and adapters to identify potential local barriers in applying research evidence to national particular clinical settings. Unnecessary efforts could be avoided by adapting existing guidelines, rather than developing them de novo [3, 4, 5]. In this summary, we briefly describe the natural history of cirrhosis, followed by PICO questions and recommendations. The review of the literature at the basis of individual recommendations is uploaded as supplementary material. Recommendations were labeled as “adopted” when the original EASL recommendation was maintained, as “new” if they were not present in the original EASL CPG, and as “adapted” when the text was modified from the original version to adapt them to the Italian context. Quality of evidence and the strength of recommendations were defined according to the GRADE II and ADOpT documents [].
Fuente: Digestive and Liver Disease 53 (2021) 1089–1104. DOI:https://doi.org/10.1016/j.dld.2021.06.021