In October 2008, the European Association for the Study of the Liver (EASL) proudly published its first Clinical Practice Guidelines on the "Management of chronic hepatitis B". Just eight months later, Europe's leading association of medical professionals is ready to publish new subject matter in the same series of Clinical Practice Guidelines (CPG), this time on the 'Management of cholestatic liver diseases'.
The EASL guidelines are available in a downloadable format directly via the EASL website (http://www.easl.ch/) and aim to define the use of diagnostic, therapeutic and preventive modalities, including non-invasive and invasive procedures, in the management of patients with cholestatic liver diseases. They are intended to assist physicians and other healthcare providers as well as patients and individuals in the clinical decision-making process by describing a range of generally accepted approaches for the diagnosis, treatment and prevention of such diseases.
It is important to recognize that clinical care for patients with cholestatic liver diseases has advanced considerably in the last decade thanks to growing insight into genetic characteristics, pathophysiological mechanisms and remarkable methodological and technical developments in diagnostic procedures as well as therapeutic and preventive approaches. However, various aspects in the care of patients with cholestatic disorders still remain completely unresolved. Importantly, chronic cholestatic liver diseases such as primary biliary cirrhosis (PBC) and primary sclerosing cholagitis (PSC) are major indications for liver transplantation. For this reason, these EASL guidelines provide the latest recommendations on diagnosis and treatment with special regard to:
- diagnostic work-up of the cholestatic patient,
- primary biliary cirrhosis (PBC),
- PBC - autoimmune hepatitis (AIH) overlap syndrome,
- primary sclerosing cholangitis (PSC),
- PSC - AIH overlap syndrome,
- immunoglobulin G4- associated cholangitis (IAC),
- drug-induced cholestatic liver diseases
- genetic cholestatic liver diseases,
- cholestatic liver diseases in pregnancy,
- drug-induced cholestasis
- extrahepatic manifestations of cholestatic liver diseases,
In May last year, the EASL Governing Board chose a panel of experts to write and assemble the Clinical Practice Guidelines that were produced from June through to November 2008 using evidence from PubMed and Cochrane database searches made before 1 October, 2008. All evidence and recommendations were graded according to the Grading of Recommendations Assessment Development and Evaluation (GRADE) system.
The strength of recommendations thus reflects the quality of underlying evidence which has been classified in one of three levels: high, moderate or low-quality evidence. The GRADE system offers two levels of recommendation: strong or weak. Consequently, the EASL guidelines consider the quality of evidence: the higher, the more likely a strong recommendation is warranted; the greater the variability in values and preferences, or the greater the uncertainty, the more likely a weaker recommendation is warranted. Where no clear evidence exists, guidance is based on the consensus advice of expert opinion in the literature and writing committee.
The writing of the Clinical Practice Guidelines is just one of many actions that EASL is devoted to in the field of cholestatic diseases. A Monothematic Conference on Primary Sclerosing Cholangitis conference will be held in Oslo, Norway, June 21-23, 2009, accredited by the European Accreditation Council for Continuing Medical Education (EACCME). The handling of patients suffering from Primary Sclerosing Cholangitis is challenging for several reasons and the central questions to be addressed during this Monothematic Conference will include:
- Epidemiology and natural history of PSC
- Pathogenesis of PSC
- Overlap syndrome and autoimmunity in PSC
- Malignancies in PSC: pathogenesis and treatment
- Transplantation in PSC incl. recurrence
EASL looks forward to seeing you in Oslo this weekend for this exciting scientific event.
EASL, whose main mission is to promote liver research and to improve the treatment of liver disease throughout the world, also supports the education of physicians and scientists, and acts as an advisor to European/National Health authorities in raising public awareness on liver disease. Our collaborative work has already given rise to many international clinical trials and extensive research in liver disease to the benefit of patients across the world. EASL's aim of involving young scientists and hepatologists in its activities, to stimulate their active contribution and to support their research has been instrumental in its success.
We sincerely hope that you find EASL's actions and Clinical Practice Guidelines constructive and we warmly welcome member's feedback. EASL shall continue to produce future guidelines to report on a broad range of significant matters in the field of hepatology.
The wide scope of the association's vocation means that work is never finished and we invite all those who wish to take up the challenge to join EASL and become part of our vision.
EASL Governing Board
|
