Austrian consensus on the diagnosis and management of portal hypertension in advanced chronic liver disease (Billroth IV)
ÖGGH · 2023 · Austria
Source and licence
- Authors
- Mattias Mandorfer, Elmar Aigner, Manfred Cejna et al.
- Title
- Austrian consensus on the diagnosis and management of portal hypertension in advanced chronic liver disease (Billroth IV)
- Journal
- Wiener Klinische Wochenschrift, 2023
- Licence
- CC BY 4.0
- Changes
- Verbatim excerpts; formatting adapted
Full text retrieved 2026-10-27 from Europe PMC · PMC10319704
Licence statement of the original publication
Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
This page reproduces excerpts of the original publication; the original is authoritative. It has not been reviewed by a physician, does not state a recommendation of Medelix and does not replace medical advice. The guideline may have been updated since.
Open the original publication →Full text on Europe PMC
Recommendations
We found no explicitly labelled recommendations in this publication; its recommendations are in the running text of the original.
Abstract
The Billroth IV consensus was developed during a consensus meeting of the Austrian Society of Gastroenterology and Hepatology (ÖGGH) and the Austrian Society of Interventional Radiology (ÖGIR) held on the 26th of November 2022 in Vienna.
Based on international recommendations and considering recent landmark studies, the Billroth IV consensus provides guidance regarding the diagnosis and management of portal hypertension in advanced chronic liver disease.
Contents of the original publication
The section headings of the original.
- Grading of certainty and recommendation
- 1. Definition, diagnosis, work-up and follow-up of compensated advanced chronic liver disease (cACLD)
- Definition of cACLD
- Diagnosis of cACLD
- Work-up and follow-up of patients with cACLD, or without
- 2. Measurement of the hepatic venous pressure gradient
- 3. Non-invasive staging of portal hypertension in patients with cACLD/compensated cirrhosis
- General considerations
- Ruling-out and ruling-in CSPH and indication for esophagogastroduodenoscopy
- Specific patient populations
- 4. Endoscopic classifications and treatment
- Esophageal varices
- Gastroesophageal and gastric varices
- Portal-hypertensive gastropathy
- Gastric antral vascular ectasia
- 5. Prevention of first hepatic decompensation and portal hypertensive bleeding
- 6. Acute variceal bleeding
- Pre-endoscopy management
- Endoscopy
- Post-endoscopy management
- 7. Prevention of further decompensation
- Definition of ‘further decompensation’
- Definition of acute-on-chronic liver failure (ACLF)
- Definition of cirrhosis recompensation
- Preventing recurrent variceal haemorrhage (secondary prophylaxis)
- Definition and diagnosis of hepatic encephalopathy (HE)
- Treatment of first, recurrent, and persistent HE
- Preventing further decompensation in patients with ascites or HE
- Role of infections in decompensated cirrhosis
- The role of sarcopenia and frailty in further decompensation
- 8. Management of ascites and hepatic hydrothorax
- Diagnostic approach in patients with ascites
- Therapy of uncomplicated ascites
- Recurrent ascites
- Refractory ascites
- Hepatic hydrothorax
- 9. Treatment of spontaneous bacterial peritonitis (SBP)
- 10. Renal impairment
- Definition, diagnosis and staging of acute kidney injury in ACLD
- Definition and diagnosis of HRS-AKI
- Management of AKI in ACLD
- Management of HRS-AKI and HRS-NAKI
- Vasoconstrictor treatment
- Assessment of response to vasopressor treatment and further management
- Role of TIPS in the treatment of HRS-AKI and HRS-NAKI
- Role of RRT and ELS in HRS-AKI and HRS-NAKI
- Role of liver transplantation in HRS-AKI and HRS-NAKI
- 11. Transjugular intrahepatic portosystemic shunt (TIPS): evaluation, technical aspects, and follow-up
- Evaluation for elective TIPS placement
- Evaluation for acute (‘pre-emptive’ or ‘early’ and ‘rescue’) TIPS placement
- Investigations suggested prior to TIPS placement
- Absolute contraindications for TIPS placement
- Relative contraindications for TIPS placement
- Technical aspects of transjugular intrahepatic portosystemic shunt (TIPS) placement
- Follow-up after TIPS placement
- 12. Portal vein thrombosis (PVT) in ACLD
- Screening and diagnosis
- Characterization of a newly diagnosed PVT
- Prognosis following PVT development in ACLD
- Indications for anticoagulation
- Duration of anticoagulation and choice of drug
- Follow-up evaluation
- Prevention of bleeding events
- TIPS implantation for PVT in ACLD patients
- PVT in ACLD patients with hepatic malignancies
A question about this guideline?
Medelix answers clinical questions from guidelines and studies – every statement with its source.
Are you the rights holder and object to this reproduction? Write to contact@medelix.ai and we will take the page down promptly. Imprint