{"id":9515,"date":"2021-11-10T21:32:06","date_gmt":"2021-11-10T21:32:06","guid":{"rendered":"https:\/\/medicalcriteria.com\/web\/?p=9515"},"modified":"2025-12-30T20:29:51","modified_gmt":"2025-12-30T20:29:51","slug":"baveno-vi","status":"publish","type":"post","link":"https:\/\/medicalcriteria.com\/web\/baveno-vi\/","title":{"rendered":"Baveno VI Criteria for Compensated Advanced Chronic Liver Disease (cACLD)"},"content":{"rendered":"<div class=\"99c380e4b4a7b96c35d7ddf7dcb434e8\" data-index=\"1\" style=\"float: none; margin:0px 0 0px 0; text-align:center;\">\n<script async src=\"https:\/\/pagead2.googlesyndication.com\/pagead\/js\/adsbygoogle.js\"><\/script>\r\n<!-- MC 2019- Horizontal -->\r\n<ins class=\"adsbygoogle\"\r\n     style=\"display:block\"\r\n     data-ad-client=\"ca-pub-0127150553352455\"\r\n     data-ad-slot=\"3806776041\"\r\n     data-ad-format=\"auto\"\r\n     data-full-width-responsive=\"true\"><\/ins>\r\n<script>\r\n     (adsbygoogle = window.adsbygoogle || []).push({});\r\n<\/script>\n<\/div>\n<p>Portal hypertension is the haemodynamic abnormality associated with the most severe complications of cirrhosis, including ascites, hepatic encephalopathy and bleeding from gastroesophageal varices. Variceal bleeding is a medical emergency associated with a mortality that, in spite of recent progress, is still in the order of 10\u201320% at 6 weeks. The evaluation of diagnostic tools and the design and conduct of good clinical trials for the treatment of portal hypertension have always been difficult. <!--more--><\/p>\n<p><strong>Definition of compensated advanced chronic liver disease<\/strong><\/p>\n<ul>\n<li>The introduction of transient elastography (TE) in clinical practice has allowed the early identification of patients with chronic liver disease (CLD) at risk of developing clinically significant portal hypertension (CSPH).<\/li>\n<li>For these patients, the alternative term \u2018\u2018compensated advanced chronic liver disease (cACLD)\u2019\u2019 has been proposed to better reflect that the spectrum of severe fibrosis and cirrhosis is a continuum in asymptomatic patients, and that distinguishing between the two is often not possible on clinical grounds.<\/li>\n<li>Currently, both terms: \u2018\u2018cACLD\u2019\u2019 and \u2018\u2018compensated cirrhosis\u2019\u2019 are acceptable.<\/li>\n<li>Patients with suspicion of cACLD should be referred to a liver disease specialist for confirmation, follow-up and treatment.<\/li>\n<\/ul>\n<p><strong>Criteria to suspect cACLD<\/strong><\/p>\n<ul>\n<li>Liver stiffness by TE is sufficient to suspect cACLD in asymptomatic subjects with known causes of CLD.<\/li>\n<li>TE often has false positive results; hence two measurements on different days are recommended in fasting conditions.<\/li>\n<li>TE values &lt;10 kPa in the absence of other known clinical signs rule out cACLD; values between 10 and 15 kPa are suggestive of cACLD but need further test for confirmation; values &gt;15 kPa are highly suggestive of cACLD.<\/li>\n<\/ul>\n<p><strong>Criteria to confirm cACLD<\/strong><\/p>\n<ul>\n<li>Invasive methods are employed in referral centres in a stepwise approach when the diagnosis is in doubt or as<br \/>\nconfirmatory tests\u00a0Methods and findings that confirm the diagnosis of cACLD are:<\/p>\n<ul>\n<li>Liver biopsy showing severe fibrosis or established cirrhosis.<\/li>\n<li>Collagen proportionate area (CPA) measurement on histology provides quantitative data on the amount of fibrosis and holds prognostic value and its assessment is recommended.<\/li>\n<li>Upper GI endoscopy showing gastroesophageal varices.<\/li>\n<li>Hepatic venous pressure gradient (HVPG) measurement; values &gt;5 mmHg indicate sinusoidal portal hypertension.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p><strong>Diagnosis of CSPH in patients with cACLD<\/strong><\/p>\n<ul>\n<li>HVPG measurement is the gold-standard method to assess the presence of CSPH, which is defined as HVPG \u226510 mmHg.<\/li>\n<li>By definition, patients without CSPH have no gastro-oesophageal varices, and have a low five year risk of developing them.<\/li>\n<li>In patients with virus related cACLD non-invasive methods are sufficient to rule-in CSPH, defining the group of patients at risk of having endoscopic signs of PH. The following can be used:\n<ul>\n<li>Liver stiffness by TE (\u226520\u201325 kPa; at least two measurements on different days in fasting condition; caution should be paid to flares of ALT; refer to EASL guidelines for correct interpretation criteria), alone or combined to platelets and spleen size.<\/li>\n<\/ul>\n<\/li>\n<li>The diagnostic value of TE for CSPH in other aetiologies remains to be ascertained.<\/li>\n<li>Imaging showing collateral circulation is sufficient to rule-in CSPH in patients with cACLD of all aetiologies.<\/li>\n<\/ul>\n<p><strong>Identification of patients with cACLD who can safely avoid screening endoscopy<\/strong><\/p>\n<ul>\n<li>Patients with a liver stiffness &lt;20 kPa and with a platelet count &gt;150,000 have a very low risk of having varices requiring treatment, and can avoid screening endoscopy.<\/li>\n<li>These patients can be followed up by yearly repetition of TE and platelet count.<\/li>\n<li>If liver stiffness increases or platelet count declines, these patients should undergo screening esophagogastroduodenoscopy.<\/li>\n<\/ul>\n<p><strong>Surveillance of oesophageal varices<\/strong><\/p>\n<ul>\n<li>In compensated patients with no varices at screening endoscopy and with ongoing liver injury (e.g. active drinking in alcoholics, lack of SVR in HCV), surveillance endoscopy should be repeated at 2 year intervals.<\/li>\n<li>In compensated patients with small varices and with ongoing liver injury (e.g. active drinking in alcoholics,<br \/>\nlack of SVR in HCV), surveillance endoscopy should be repeated at one year intervals.<\/li>\n<li>In compensated patients with no varices at screening endoscopy in whom the aetiological factor has been<br \/>\nremoved (e.g. achievement of SVR in HCV; long-lasting abstinence in alcoholics) and who have no co-factors<br \/>\n(e.g. obesity), surveillance endoscopy should be repeated at three year intervals.<\/li>\n<li>In compensated patients with small varices at screening endoscopy in whom the aetiological factor has been<br \/>\nremoved (e.g. achievement of SVR in HCV; long-lasting abstinence in alcoholics) and who have no co-factors<br \/>\n(e.g. obesity), surveillance endoscopy should be repeated at two year intervals.<\/li>\n<\/ul>\n<p>Abbreviations: Sustained Virologic Response (SVR), Hepatitis C Virus (HCV).<\/p>\n<p>&nbsp;<\/p>\n<p><strong>References:<\/strong><\/p>\n<ol>\n<li>de Franchis R; Baveno VI Faculty. Expanding consensus in portal hypertension: Report of the Baveno VI Consensus Workshop: Stratifying risk and individualizing care for portal hypertension. J Hepatol. 2015 Sep;63(3):743-52. <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/26047908\/\" target=\"_blank\" rel=\"noopener\">[Medline]<\/a><\/li>\n<li>Vuille-Lessard \u00c9, Rodrigues SG, Berzigotti A. Noninvasive Detection of Clinically Significant Portal Hypertension in Compensated Advanced Chronic Liver Disease. Clin Liver Dis. 2021 May;25(2):253-289. <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/33838850\/\" target=\"_blank\" rel=\"noopener\">[Medline]<\/a><\/li>\n<li>Podrug K, Trkulja V, Zelenika M, Bokun T, Madir A, Kanizaj TF, O&#8217;Beirne J, Grgurevic I. Validation of the New Diagnostic Criteria for Clinically Significant Portal Hypertension by Platelets and Elastography. Dig Dis Sci. 2021 Nov 5:1\u20136. <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/34739624\/\" target=\"_blank\" rel=\"noopener\">[Medline]<\/a><\/li>\n<\/ol>\n<p>&nbsp;<\/p>\n<p>Created Nov 09, 2021.<\/p>\n\n<div style=\"font-size: 0px; height: 0px; line-height: 0px; margin: 0; padding: 0; clear: both;\"><\/div>","protected":false},"excerpt":{"rendered":"<p>Sorry, this entry is only available in Espa\u00f1ol.<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_lmt_disableupdate":"no","_lmt_disable":"no","_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"categories":[53],"tags":[2446,2447,2444,146,2448,2445,16,15,145,51,50,647,524],"class_list":["post-9515","post","type-post","status-publish","format-standard","hentry","category-gastroenterology","tag-advanced","tag-avanzada","tag-baveno","tag-chronic","tag-compensada","tag-compensated","tag-criteria","tag-criterios","tag-cronica","tag-disease","tag-enfermedad","tag-hepatica","tag-liver"],"modified_by":"Guillermo Firman","_links":{"self":[{"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/posts\/9515","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/comments?post=9515"}],"version-history":[{"count":11,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/posts\/9515\/revisions"}],"predecessor-version":[{"id":9532,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/posts\/9515\/revisions\/9532"}],"wp:attachment":[{"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/media?parent=9515"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/categories?post=9515"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/tags?post=9515"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}