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World J Gastroenterol. May 14, 2011; 17(18): 2273-2282
Published online May 14, 2011. doi: 10.3748/wjg.v17.i18.2273
Management of liver cirrhosis between primary care and specialists
Ignazio Grattagliano, Enzo Ubaldi, Leonilde Bonfrate, Piero Portincasa
Ignazio Grattagliano, Enzo Ubaldi, Italian College of General Practitioners, (SIMG), Via del Pignoncino, 9-11 50142 Firenze, Italy
Leonilde Bonfrate, Piero Portincasa, Clinica Medica “A. Murri”, Department of Internal and Public Medicine, University Medical School of Bari, P.zza G. Cesare 11-70124 Bari, Italy
Author contributions: Grattagliano I wrote the paper, Bonfrate L searched the literature, Ubaldi E designed the structure of the article, Portincasa P helped with the writing, and correction of the paper.
Correspondence to: Piero Portincasa, MD, PhD, Department of Internal and Public Medicine, University Medical School of Bari, P.zza G. Cesare 11-70124 Bari, Italy. p.portincasa@semeiotica.uniba.it
Telephone: +39-80-5478227 Fax: +39-80-5478232
Received: January 21, 2011
Revised: February 21, 2011
Accepted: February 28, 2011
Published online: May 14, 2011

This article discusses a practical, evidence-based approach to the diagnosis and management of liver cirrhosis by focusing on etiology, severity, presence of complications, and potential home-managed treatments. Relevant literature from 1985 to 2010 (PubMed) was reviewed. The search criteria were peer-reviewed full papers published in English using the following MESH headings alone or in combination: “ascites”, “liver fibrosis”, “cirrhosis”, “chronic hepatitis”, “chronic liver disease”, “decompensated cirrhosis”, “hepatic encephalopathy”, “hypertransaminasemia”, “liver transplantation” and “portal hypertension”. Forty-nine papers were selected based on the highest quality of evidence for each section and type (original, randomized controlled trial, guideline, and review article), with respect to specialist setting (Gastroenterology, Hepatology, and Internal Medicine) and primary care. Liver cirrhosis from any cause represents an emerging health issue due to the increasing prevalence of the disease and its complications worldwide. Primary care physicians play a key role in early identification of risk factors, in the management of patients for improving quality and length of life, and for preventing complications. Specialists, by contrast, should guide specific treatments, especially in the case of complications and for selecting patient candidates for liver transplantation. An integrated approach between specialists and primary care physicians is essential for providing better outcomes and appropriate home care for patients with liver cirrhosis.

Keywords: Ascites, Family medicine, Hepatic encephalopathy, Hypertransaminasemia, Portal hypertension