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Cirrhosis in over 16s: assessment and management



Risk of complications

  • Refer people who have, or are at high risk of, complications of cirrhosis to a specialist hepatology centre
  • Calculate the Model for End‑Stage Liver Disease (MELD) score every 6months for people with compensated cirrhosis
  • Consider using a MELD score of 12 or more as an indicator that the person is at high risk of complications of cirrhosis

Hepatocellular carcinoma

Oesophageal varices

  • After a diagnosis of cirrhosis, offer upper gastrointestinal endoscopy to detect oesophageal varices
  • For people in whom no oesophageal varices have been detected, offer surveillance using upper gastrointestinal endoscopy every 3years

Managing complications

  • Offer endoscopic variceal band ligation for the primary prevention of bleeding for people with cirrhosis who have medium to large oesophageal varices
  • Offer prophylactic intravenous antibiotics for people with cirrhosis who have upper gastrointestinal bleeding
  • Review intravenous antibiotics prescriptions in line with the prescribing intravenous antimicrobials section in NICE's antimicrobial stewardship guideline
  • Consider a transjugular intrahepatic portosystemic shunt for people with cirrhosis who have refractory ascites
  • Offer prophylactic oral ciprofloxacin or norfloxacin* for people with cirrhosis and ascites with an ascitic protein of 15 g/litre or less, until the ascites has resolved

*At the time of publication (July 2016), neither ciprofloxacin nor norfloxacin had a UK marketing authorisation for this indication. The prescriber should follow relevant professional guidance, taking full responsibility for the decision. Informed consent should be obtained and documented. See the General Medical Council's Good practice in prescribing medicines—guidance for doctors for further information.


full guideline available from…
National Institute for Health and Care Excellence, Level 1A, City Tower, Piccadilly Plaza, Manchester, M1 4BT

National Institute for Health and Care Excellence. Cirrhosis in over 16s: assessment and management. July 2016
First included: July 2016.

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Read the Guidelines in Practice article Identifying people at risk of liver disease progression is crucial for more information on implementing NICE Guideline (NG) 49 on Non-alcoholic fatty liver disease (NAFLD): assessment and management and NG50 on Cirrhosis in over 16s: assessment and management