Published online Sep 27, 2019. doi: 10.4254/wjh.v11.i9.663
Peer-review started: April 17, 2019
First decision: June 3, 2019
Revised: June 18, 2019
Accepted: July 16, 2019
Article in press: July 17, 2019
Published online: September 27, 2019
The global population is aging, and so the number of older cirrhotic patients is increasing. Older patients are characterised by a risk of frailty and comorbidities, and age is a risk factor for mortality in cirrhotic patients. The incidence of non-alcoholic fatty liver disease as an aetiology of cirrhosis is increasing, while that of chronic viral hepatitis is decreasing. Also, cirrhosis is frequently idiopathic. The management of portal hypertension in older cirrhotic patients is similar to that in younger patients, despite the greater risk of treatment-related adverse events of the former. The prevalence of hepatocellular carcinoma increases with age, but its treatment is unaffected. Liver transplantation is generally recommended for patients < 70 years of age. Despite the increasing prevalence of cirrhosis in older people, little data are available and few recommendations have been proposed. This review suggests that comorbidities have a considerable impact on older cirrhotic patients.
Core tip: Few large studies have addressed the needs of older cirrhotic patients. The concept of healthy ageing is increasingly important. Cirrhosis is underdiagnosed in older patients, and comorbidities, comedications, and frailty impact the prognosis. The frequency of non-alcoholic fatty liver disease as an aetiology of cirrhosis is increasing, while that of viral hepatitis is decreasing, and the role of alcohol consumption is underestimated. The management of complications in older cirrhotic patients is similar to that in younger patients despite the higher risk of treatment-related adverse events. Therapeutic indications for a transjugular intrahepatic portosystemic shunt or admission to an intensive care unit should be carefully considered. Finally, older patients require tailored exercise and nutrition programs, and treatment of osteoporosis is crucial.