NDLI: New therapeutic paradigm for patients with cirrhosis.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Tsochatzis, Emmanuel A. Bosch, Jaime Burroughs, Andrew K.
Description	Country affiliation: United kingdom Author Affiliation: Tsochatzis EA ( Royal Free Sheila Sherlock Liver Centre, London, UK.)
Abstract	Cirrhosis is a major health problem, being the 5th cause of death in the U.K. and 12th in the U.S., but 4th in the 45 to 54 age group. Until recently cirrhosis was considered a single and terminal disease stage, with an inevitably poor prognosis. However, it is now clear that 1-year mortality can range from 1% in early cirrhosis to 57% in decompensated disease. As the only treatment for advanced cirrhosis is liver transplantation, what is urgently needed is strategies to prevent transition to decompensated stages. The evidence we present in this review clearly demonstrates that management of patients with cirrhosis should change from an expectant algorithm that treats complications as they occur, to preventing the advent of all complications while in the compensated phase. This requires maintaining patients in an asymptomatic phase and not significantly affecting their quality of life with minimal impairment due to the therapies themselves. This could be achieved with lifestyle changes and combinations of already licensed and low-cost drugs, similar to the paradigm of treating risk factors for cardiovascular disease. The drugs are propranolol, simvastatin, norfloxacin, and warfarin, which in combination would cost £128/patient annually-equivalent to U.S. \$196/year. This treatment strategy requires randomized controlled trials to establish improvements in outcomes. In the 21st century, cirrhosis should be regarded as a potentially treatable disease with currently available and inexpensive therapies.
File Format	HTM / HTML
ISSN	02709139
Issue Number	5
Volume Number	56
e-ISSN	15273350
Journal	Hepatology
Language	English
Publisher	Wiley
Publisher Date	2012-11-01
Publisher Place	United States
Access Restriction	Subscribed
Subject Keyword	Discipline Hepatology Life Style Liver Cirrhosis Therapy Liver Failure Prevention & Control Adrenergic Beta-antagonists Therapeutic Use Anti-bacterial Agents Anticoagulants Humans Hydroxymethylglutaryl-coa Reductase Inhibitors Complications Economics Etiology Journal Article Review
Content Type	Text
Resource Type	Article
Subject	Hepatology

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