Cargando…
Evolution of care in cirrhosis: Preventing hepatic decompensation through pharmacotherapy
Cirrhosis is a leading cause of morbidity and mortality, impacting more than 120 million people worldwide. Although geographic differences exist, etiologic factors such as alcohol use disorder, chronic viral hepatitis infections, and non-alcoholic fatty liver disease are prevalent in nearly every re...
Autores principales: | , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Baishideng Publishing Group Inc
2023
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9850948/ https://www.ncbi.nlm.nih.gov/pubmed/36683719 http://dx.doi.org/10.3748/wjg.v29.i1.61 |
_version_ | 1784872298684088320 |
---|---|
author | Lee, Seohyuk Saffo, Saad |
author_facet | Lee, Seohyuk Saffo, Saad |
author_sort | Lee, Seohyuk |
collection | PubMed |
description | Cirrhosis is a leading cause of morbidity and mortality, impacting more than 120 million people worldwide. Although geographic differences exist, etiologic factors such as alcohol use disorder, chronic viral hepatitis infections, and non-alcoholic fatty liver disease are prevalent in nearly every region. Historically, significant effort has been devoted to modifying these risks to prevent disease progression. Nevertheless, more than 11% of patients with compensated cirrhosis experience hepatic decompensation each year. This transition signifies the most important prognostic factor in the natural history of the disease, corresponding to a decline in median survival to below 2 years. Over the past decade, the need for pharmacotherapies aimed at reducing the risk for hepatic decompensation has been emphasized, and non-selective beta-blockers have emerged as the most effective option to date. However, a critical therapeutic gap still exists, and additional therapies have been proposed, including statins, rifaximin, and sodium-glucose cotransporter-2 inhibitors. Based on the results of innovative retrospective analyses and small-scale prospective trials, these pharmacotherapies represent promising options, but further studies, including randomized controlled trials, are necessary before they can be incorporated into clinical use. This report highlights the potential impact of these agents and others in preventing hepatic decompensation and discusses how this paradigm shift may pave the way for guideline-directed medical therapy in cirrhosis. |
format | Online Article Text |
id | pubmed-9850948 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Baishideng Publishing Group Inc |
record_format | MEDLINE/PubMed |
spelling | pubmed-98509482023-01-20 Evolution of care in cirrhosis: Preventing hepatic decompensation through pharmacotherapy Lee, Seohyuk Saffo, Saad World J Gastroenterol Review Cirrhosis is a leading cause of morbidity and mortality, impacting more than 120 million people worldwide. Although geographic differences exist, etiologic factors such as alcohol use disorder, chronic viral hepatitis infections, and non-alcoholic fatty liver disease are prevalent in nearly every region. Historically, significant effort has been devoted to modifying these risks to prevent disease progression. Nevertheless, more than 11% of patients with compensated cirrhosis experience hepatic decompensation each year. This transition signifies the most important prognostic factor in the natural history of the disease, corresponding to a decline in median survival to below 2 years. Over the past decade, the need for pharmacotherapies aimed at reducing the risk for hepatic decompensation has been emphasized, and non-selective beta-blockers have emerged as the most effective option to date. However, a critical therapeutic gap still exists, and additional therapies have been proposed, including statins, rifaximin, and sodium-glucose cotransporter-2 inhibitors. Based on the results of innovative retrospective analyses and small-scale prospective trials, these pharmacotherapies represent promising options, but further studies, including randomized controlled trials, are necessary before they can be incorporated into clinical use. This report highlights the potential impact of these agents and others in preventing hepatic decompensation and discusses how this paradigm shift may pave the way for guideline-directed medical therapy in cirrhosis. Baishideng Publishing Group Inc 2023-01-07 2023-01-07 /pmc/articles/PMC9850948/ /pubmed/36683719 http://dx.doi.org/10.3748/wjg.v29.i1.61 Text en ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved. https://creativecommons.org/licenses/by-nc/4.0/This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/ |
spellingShingle | Review Lee, Seohyuk Saffo, Saad Evolution of care in cirrhosis: Preventing hepatic decompensation through pharmacotherapy |
title | Evolution of care in cirrhosis: Preventing hepatic decompensation through pharmacotherapy |
title_full | Evolution of care in cirrhosis: Preventing hepatic decompensation through pharmacotherapy |
title_fullStr | Evolution of care in cirrhosis: Preventing hepatic decompensation through pharmacotherapy |
title_full_unstemmed | Evolution of care in cirrhosis: Preventing hepatic decompensation through pharmacotherapy |
title_short | Evolution of care in cirrhosis: Preventing hepatic decompensation through pharmacotherapy |
title_sort | evolution of care in cirrhosis: preventing hepatic decompensation through pharmacotherapy |
topic | Review |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9850948/ https://www.ncbi.nlm.nih.gov/pubmed/36683719 http://dx.doi.org/10.3748/wjg.v29.i1.61 |
work_keys_str_mv | AT leeseohyuk evolutionofcareincirrhosispreventinghepaticdecompensationthroughpharmacotherapy AT saffosaad evolutionofcareincirrhosispreventinghepaticdecompensationthroughpharmacotherapy |