2023
AGA Clinical Practice Update on the Use of Vasoactive Drugs and Intravenous Albumin in Cirrhosis: Expert Review
Garcia-Tsao G, Abraldes J, Rich N, Wong V. AGA Clinical Practice Update on the Use of Vasoactive Drugs and Intravenous Albumin in Cirrhosis: Expert Review. Gastroenterology 2023, 166: 202-210. PMID: 37978969, DOI: 10.1053/j.gastro.2023.10.016.Peer-Reviewed Original ResearchConceptsSpontaneous bacterial peritonitisAcute kidney injuryLarge-volume paracentesisEffective arterial blood volumeVasoactive drugsVariceal hemorrhageArterial blood volumeHRS-AKIUncomplicated ascitesIntravenous albuminVolume statusPractice UpdateBlood volumeChronic liver failure grade 3Best practice advice statementsClinical Practice Updates CommitteeEnd-stage liver diseaseAGA Clinical Practice UpdateForms of AKIIntensive care unit monitoringAGA Governing BoardCombination of vasoconstrictorsInitial endoscopic hemostasisPatient's volume statusClinical Practice UpdateUpdate in the Treatment of the Complications of Cirrhosis
Abraldes J, Caraceni P, Ghabril M, Garcia-Tsao G. Update in the Treatment of the Complications of Cirrhosis. Clinical Gastroenterology And Hepatology 2023, 21: 2100-2109. PMID: 36972759, PMCID: PMC11097249, DOI: 10.1016/j.cgh.2023.03.019.Peer-Reviewed Reviews, Practice Guidelines, Standards, and Consensus StatementsMeSH KeywordsAscitesEsophageal and Gastric VaricesGastrointestinal HemorrhageHepatic EncephalopathyHumansLiver CirrhosisPortasystemic Shunt, Transjugular IntrahepaticQuality of LifeTreatment OutcomeVaricose VeinsConceptsTransjugular intrahepatic portosystemic shuntVariceal hemorrhageHepatic encephalopathyPre-emptive transjugular intrahepatic portosystemic shuntsAcute variceal hemorrhageCombination of terlipressinAcute kidney injuryComplications of cirrhosisSecond-line treatmentSignificant portal hypertensionFirst-line treatmentLeast common causePrognosis of patientsOrnithine L-aspartatePresence of varicesIntrahepatic portosystemic shuntStandard of careQuality of lifeCyanoacrylate injectionHepatorenal syndromeUncomplicated ascitesKidney injuryPortal hypertensionRefractory ascitesAlbumin use
2021
Baveno VII – Renewing consensus in portal hypertension
de Franchis R, Bosch J, Garcia-Tsao G, Reiberger T, Ripoll C, Faculty B, Abraldes J, Albillos A, Baiges A, Bajaj J, Bañares R, Barrufet M, Benajiba L, Berzigotti A, Bureau C, Calvaruso V, Cardenas A, D’Amico G, De Gottardi A, Dell’Era A, Escorsell A, Fallowfield J, Ferral H, Francque S, Gaba R, Garcia-Pagàn J, Genescà J, Rodrigues S, Gracia-Sancho J, Han G, Hernandez-Gea V, Jia J, Kiladjian J, Krag A, Laleman W, La Mura V, Lens S, Luo X, Mandorfer M, Murad S, Paradis V, Patch D, Piano S, Pinzani M, Plessier A, Primignani M, Procopet B, Rautou P, Rudler M, Sarin S, Schepis F, Senzolo M, Shah V, Shukla A, Tandon P, Tellez L, Thabut D, Thiele M, Trebicka J, Tripathi D, Tsochatzis E, Turco L, Turon F, Valla D, Villanueva C, Wanless I, Yoshiji H. Baveno VII – Renewing consensus in portal hypertension. Journal Of Hepatology 2021, 76: 959-974. PMID: 35120736, PMCID: PMC11090185, DOI: 10.1016/j.jhep.2021.12.022.Peer-Reviewed Original ResearchMeSH KeywordsElasticity Imaging TechniquesEsophageal and Gastric VaricesHumansHypertension, PortalLiver CirrhosisPortal PressureConceptsPortal hypertensionAdvanced chronic liver diseaseHepatic venous pressure gradientAcute bleeding episodeSignificant portal hypertensionVenous pressure gradientChronic liver diseaseSplanchnic vein thrombosisCourse of cirrhosisRisk of deathNon-invasive toolBleeding episodesCompensated cirrhosisFurther decompensationVein thrombosisLiver diseaseBaveno VIVascular disordersFirst episodeHypertensionPersonalized careMedical literatureTherapeutic needsGold standardCirrhosisSACRED: Effect of simvastatin on hepatic decompensation and death in subjects with high-risk compensated cirrhosis: Statins and Cirrhosis: Reducing Events of Decompensation
Kaplan D, Mehta R, Garcia-Tsao G, Albrecht J, Aytaman A, Baffy G, Bajaj J, Hernaez R, Hunt K, Ioannou G, Johnson K, Kanwal F, Lee T, Monto A, Pandya P, Schaubel D, Taddei T. SACRED: Effect of simvastatin on hepatic decompensation and death in subjects with high-risk compensated cirrhosis: Statins and Cirrhosis: Reducing Events of Decompensation. Contemporary Clinical Trials 2021, 104: 106367. PMID: 33771685, PMCID: PMC8422958, DOI: 10.1016/j.cct.2021.106367.Peer-Reviewed Original ResearchMeSH KeywordsEsophageal and Gastric VaricesFibrosisGastrointestinal HemorrhageHumansHydroxymethylglutaryl-CoA Reductase InhibitorsLiver CirrhosisLiver NeoplasmsProspective StudiesRetrospective StudiesSimvastatinConceptsHepatic decompensationPortal hypertensionEvents of decompensationHepatic decompensation eventsLiver-related deathSignificant portal hypertensionAcceptable safety profileProspective human studiesRole of statinsChronic liver diseaseClasses of medicationsPatient-reported outcomesDevelopment of decompensationEffect of simvastatinVA Medical CenterCompensated cirrhosisDecompensation eventsStatin therapyVariceal hemorrhageCirrhotic patientsStandard therapyVascular reactivityExert pleiotropic effectsLiver diseaseRetrospective studyVascular Liver Disorders, Portal Vein Thrombosis, and Procedural Bleeding in Patients With Liver Disease: 2020 Practice Guidance by the American Association for the Study of Liver Diseases
Northup PG, Garcia‐Pagan J, Garcia‐Tsao G, Intagliata NM, Superina RA, Roberts LN, Lisman T, Valla DC. Vascular Liver Disorders, Portal Vein Thrombosis, and Procedural Bleeding in Patients With Liver Disease: 2020 Practice Guidance by the American Association for the Study of Liver Diseases. Hepatology 2021, 73: 366-413. PMID: 33219529, DOI: 10.1002/hep.31646.Peer-Reviewed Reviews, Practice Guidelines, Standards, and Consensus StatementsMeSH KeywordsDisease ManagementEsophageal and Gastric VaricesGastrointestinal HemorrhageHumansLiver CirrhosisPortal VeinRisk AssessmentSocieties, MedicalUnited StatesVaricose Veins
2020
Ordinal Outcomes Are Superior to Binary Outcomes for Designing and Evaluating Clinical Trials in Compensated Cirrhosis
D’Amico G, Abraldes JG, Rebora P, Valsecchi MG, Garcia‐Tsao G. Ordinal Outcomes Are Superior to Binary Outcomes for Designing and Evaluating Clinical Trials in Compensated Cirrhosis. Hepatology 2020, 72: 1029-1042. PMID: 31837238, PMCID: PMC11090179, DOI: 10.1002/hep.31070.Peer-Reviewed Original ResearchConceptsClinical trialsGrade 1Prevention of decompensationBaseline platelet countDevelopment of varicesSignificant outcome differencesLow baseline riskPrimary therapeutic targetCirrhosis decompensationCompensated cirrhosisInception cohortComposite endpointEsophageal varicesPlatelet countBinary outcomesDisease progressionSignificant treatment effectBaseline riskGrade 3Sample sizeOutcome differencesTherapeutic targetDecompensationGrade 2Larger sample size
2017
Stratifying risk in the prevention of recurrent variceal hemorrhage: Results of an individual patient meta‐analysis
Albillos A, Zamora J, Martínez J, Arroyo D, Ahmad I, De‐la‐Peña J, Garcia‐Pagán J, Lo G, Sarin S, Sharma B, Abraldes JG, Bosch J, Garcia‐Tsao G, Cooperation O. Stratifying risk in the prevention of recurrent variceal hemorrhage: Results of an individual patient meta‐analysis. Hepatology 2017, 66: 1219-1231. PMID: 28543862, PMCID: PMC5605404, DOI: 10.1002/hep.29267.Peer-Reviewed Original ResearchMeSH KeywordsAdrenergic beta-AntagonistsCombined Modality TherapyEsophageal and Gastric VaricesEsophagoscopyGastrointestinal HemorrhageHumansLiver CirrhosisRisk AssessmentSecondary PreventionConceptsChild B/CPrevious variceal bleedingCombination therapyVariceal bleedingCirrhosis severityChild APrognostic stageRecurrent variceal hemorrhageAdvanced liver failureEndoscopic variceal ligationOutcome of therapyVariceal hemorrhageLiver failureVariceal ligationLiver functionPatientsPatient careVaricealTherapyPatient dataMortalityTrialsCirrhosisBleedingProphylaxisValidating, deconstructing and refining Baveno criteria for ruling out high‐risk varices in patients with compensated cirrhosis
Jangouk P, Turco L, De Oliveira A, Schepis F, Villa E, Garcia‐Tsao G. Validating, deconstructing and refining Baveno criteria for ruling out high‐risk varices in patients with compensated cirrhosis. Liver International 2017, 37: 1177-1183. PMID: 28160373, PMCID: PMC5511584, DOI: 10.1111/liv.13379.Peer-Reviewed Original ResearchConceptsHigh-risk varicesNegative predictive valueBaveno VI criteriaLiver stiffnessBaveno criteriaPredictive valueItalian cohortPlatelet countNon-invasive criteriaCohort of patientsNumber of endoscopiesUnnecessary endoscopiesCompensated cirrhosisPrimary prophylaxisRetrospective studyUS cohortVariceal screeningTransient elastographyVaricesHigh riskLow prevalenceCirrhosisPatientsEndoscopyClinical diagnosis
2016
Portal hypertensive bleeding in cirrhosis: Risk stratification, diagnosis, and management: 2016 practice guidance by the American Association for the study of liver diseases
Garcia‐Tsao G, Abraldes JG, Berzigotti A, Bosch J. Portal hypertensive bleeding in cirrhosis: Risk stratification, diagnosis, and management: 2016 practice guidance by the American Association for the study of liver diseases. Hepatology 2016, 65: 310-335. PMID: 27786365, DOI: 10.1002/hep.28906.Peer-Reviewed Reviews, Practice Guidelines, Standards, and Consensus Statements
2014
Novel inflammatory biomarkers of portal pressure in compensated cirrhosis patients
Buck M, Garcia‐Tsao G, Groszmann RJ, Stalling C, Grace ND, Burroughs AK, Patch D, Matloff DS, Clopton P, Chojkier M. Novel inflammatory biomarkers of portal pressure in compensated cirrhosis patients. Hepatology 2014, 59: 1052-1059. PMID: 24115225, DOI: 10.1002/hep.26755.Peer-Reviewed Original ResearchConceptsHepatic vein pressure gradientGastroesophageal varicesCirrhosis patientsUnnecessary esophagogastroduodenoscopyPortal hypertensionInflammatory biomarkersMultivariate logistic regression analysisInflammatory serum biomarkersNovel inflammatory biomarkerSerum VCAM-1Logistic regression analysisAssociated morbidityCohort studyPortal pressureLiver injuryBlood testsClinical parametersInflammatory pathwaysSerum biomarkersClinical trialsVCAM-1IL-1RPatientsDiagnostic testsMmHg
2012
When the Spleen Gets Tough, the Varices Get Going
Castéra L, García–Tsao G. When the Spleen Gets Tough, the Varices Get Going. Gastroenterology 2012, 144: 19-22. PMID: 23164570, DOI: 10.1053/j.gastro.2012.11.015.Peer-Reviewed Reviews, Practice Guidelines, Standards, and Consensus StatementsElasticity Imaging TechniquesEsophageal and Gastric VaricesFemaleHumansHypertension, PortalLiver CirrhosisMaleSpleenPrognostic indicators of survival in patients with compensated and decompensated cirrhosis
Zipprich A, Garcia‐Tsao G, Rogowski S, Fleig WE, Seufferlein T, Dollinger MM. Prognostic indicators of survival in patients with compensated and decompensated cirrhosis. Liver International 2012, 32: 1407-1414. PMID: 22679906, PMCID: PMC3713489, DOI: 10.1111/j.1478-3231.2012.02830.x.Peer-Reviewed Original ResearchConceptsHepatic venous pressure gradientPredictors of deathCompensated patientsPortal hypertensionPrognostic valueComplications of cirrhosisSignificant portal hypertensionStage 2 patientsVenous pressure gradientDecompensated patientsSystemic haemodynamicsVariceal hemorrhagePortal pressureIndependent predictorsMultivariable analysisClinical eventsDecompensated stagePrognostic indicatorStaging systemLonger survivalBACKGROUND/CirrhosisPatientsSurvival rateAnalyse survival
2009
Pharmacological versus endoscopic therapy in the prevention of variceal hemorrhage: And the winner is…
Bosch J, Garcia‐Tsao G. Pharmacological versus endoscopic therapy in the prevention of variceal hemorrhage: And the winner is…. Hepatology 2009, 50: 674-677. PMID: 19714716, DOI: 10.1002/hep.23164.Peer-Reviewed Reviews, Practice Guidelines, Standards, and Consensus Statements
2008
Portal hypertension and variceal bleeding—Unresolved issues. Summary of an American Association for the study of liver diseases and European Association for the study of the liver single‐topic conference
Garcia‐Tsao G, Bosch J, Groszmann RJ. Portal hypertension and variceal bleeding—Unresolved issues. Summary of an American Association for the study of liver diseases and European Association for the study of the liver single‐topic conference. Hepatology 2008, 47: 1764-1772. PMID: 18435460, DOI: 10.1002/hep.22273.Peer-Reviewed Reviews, Practice Guidelines, Standards, and Consensus Statements
2007
Platelet count is not a predictor of the presence or development of gastroesophageal varices in cirrhosis
Qamar AA, Grace ND, Groszmann RJ, Garcia‐Tsao G, Bosch J, Burroughs AK, Maurer R, Planas R, Escorsell A, Garcia‐Pagan J, Patch D, Matloff DS, Makuch R, Group P. Platelet count is not a predictor of the presence or development of gastroesophageal varices in cirrhosis. Hepatology 2007, 47: 153-159. PMID: 18161700, DOI: 10.1002/hep.21941.Peer-Reviewed Original ResearchMeSH KeywordsAdultAgedCohort StudiesEsophageal and Gastric VaricesHumansLiver CirrhosisMiddle AgedModels, BiologicalPlatelet CountPortal PressureConceptsHepatic venous pressure gradientPresence of GEVsGastroesophageal varicesPlatelet countPortal hypertensionMild portal hypertensionSpecific platelet countDouble-blind trialVenous pressure gradientTime of endoscopyHVPG changesCompensated cirrhosisHVPG measurementNoninvasive testsCurrent guidelinesNoninvasive markerPatientsSecondary analysisLongitudinal evaluationCirrhosisEsophagogastroduodenoscopyHypertensionVaricesPresent longitudinal studyLongitudinal studyA pilot project examining the predicted preferences of patients and physicians in the primary prophylaxis of variceal hemorrhage
Longacre AV, Imaeda A, Garcia‐Tsao G, Fraenkel L. A pilot project examining the predicted preferences of patients and physicians in the primary prophylaxis of variceal hemorrhage. Hepatology 2007, 47: 169-176. PMID: 17935182, PMCID: PMC2674014, DOI: 10.1002/hep.21945.Peer-Reviewed Original ResearchConceptsEndoscopic variceal ligationProcedure-related bleedingVariceal hemorrhagePrimary prophylaxisPreferences of patientsRoute of administrationSexual dysfunctionFirst-line therapyShortness of breathIndividual patient preferencesUntreated patientsEsophageal varicesVariceal ligationPrimary preventionPatient preferencesRisk of fatigueTreatment preferencesProphylaxisSide effectsHemorrhagePatientsBleedingPhysiciansFuture guidelinesHypotensionPrevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis
Garcia‐Tsao G, Sanyal AJ, Grace ND, Carey W, Diseases T. Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis. Hepatology 2007, 46: 922-938. PMID: 17879356, DOI: 10.1002/hep.21907.Peer-Reviewed Reviews, Practice Guidelines, Standards, and Consensus StatementsHepatic Venous Pressure Gradient Predicts Clinical Decompensation in Patients With Compensated Cirrhosis
Ripoll C, Groszmann R, Garcia–Tsao G, Grace N, Burroughs A, Planas R, Escorsell A, Garcia–Pagan J, Makuch R, Patch D, Matloff DS, Bosch J, Group P. Hepatic Venous Pressure Gradient Predicts Clinical Decompensation in Patients With Compensated Cirrhosis. Gastroenterology 2007, 133: 481-488. PMID: 17681169, DOI: 10.1053/j.gastro.2007.05.024.Peer-Reviewed Original ResearchMeSH KeywordsAgedAscitesEsophageal and Gastric VaricesFemaleFollow-Up StudiesGastrointestinal HemorrhageHepatic EncephalopathyHumansHypertension, PortalKaplan-Meier EstimateLiver CirrhosisMaleMiddle AgedPortal PressurePredictive Value of TestsPrognosisProportional Hazards ModelsProspective StudiesRisk AssessmentRisk FactorsROC CurveSensitivity and SpecificitySeverity of Illness IndexTime FactorsConceptsHepatic venous pressure gradientVenous pressure gradientClinical decompensationPortal hypertensionMedian hepatic venous pressure gradientEnd-stage liver diseaseDiagnostic capacityBaseline laboratory testsPredictors of decompensationChild-Pugh scoreDevelopment of varicesMedical record reviewEnd of studyMedian followCompensated cirrhosisLiver transplantationLiver diseaseRecord reviewStudy terminationDecompensationPatientsCirrhosisMultivariate analysisVaricesHypertension
2001
Propranolol for the prevention of first esophageal variceal hemorrhage: A lifetime commitment?
Abraczinskas D, Ookubo R, Grace N, Groszmann R, Bosch J, Garcia‐Tsao G, Richardson C, Matloff D, Rodés J, Conn H. Propranolol for the prevention of first esophageal variceal hemorrhage: A lifetime commitment? Hepatology 2001, 34: 1096-1102. PMID: 11731997, DOI: 10.1053/jhep.2001.29305.Peer-Reviewed Original ResearchConceptsVariceal hemorrhageBeta blockersVariceal bleedingPrimary preventionFirst esophageal variceal hemorrhageWithdrawal of propranololOutcomes of patientsPlacebo-controlled trialEsophageal variceal hemorrhageGroup of patientsOriginal study populationUntreated populationBlocker therapyIndefinite administrationPlacebo groupPortal hypertensionProphylactic therapyProspective studyCumulative survivalProtective effectStudy populationHemorrhagePatientsPropranololBlockersCurrent management of the complications of cirrhosis and portal hypertension: Variceal hemorrhage, ascites, and spontaneous bacterial peritonitis
Garcia–Tsao G. Current management of the complications of cirrhosis and portal hypertension: Variceal hemorrhage, ascites, and spontaneous bacterial peritonitis. Gastroenterology 2001, 120: 726-748. PMID: 11179247, DOI: 10.1053/gast.2001.22580.Peer-Reviewed Reviews, Practice Guidelines, Standards, and Consensus StatementsMeSH KeywordsAscitesBacterial InfectionsEsophageal and Gastric VaricesGastrointestinal HemorrhageHepatorenal SyndromeHumansHypertension, PortalLiver CirrhosisPeritonitisRecurrence