A group of experts recently gathered to produce a consensus on the appropriate management of complications related to liver cirrhosis (LC) in children; the resulting guideline was published in the Journal of Mexican Gastroenterology

The causes of LC in childhood are varied, ranging from genetic disorders such as Alagille syndrome to viral infections like hepatitis B and C and exposure to toxic substances. Currently, there is scarce high-quality information on the appropriate management of LC complications in children.

The Mexican Hepatology Society aimed to address the problem by gathering experts from the fields of pediatric gastroenterology, nutrition, nephrology, and infectious disease to produce guidelines to aid in the appropriate management of LC complications in pediatric patients. 


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“We consider it important to distribute knowledge regarding detection of kids with cirrhosis, to offer timely complication management to stop its progression,“ the authors wrote.

Read more about the complications of Alagille syndrome

A total of 25 experts were divided into 8 work tables, each one with a coordinator. The tables conducted literature searches, and the coordinators of each table selected all relevant publications and shared them with the team. Each table used the selected bibliography to produce a series of statements and recommendations. 

Each statement was evaluated through a Delphi voting system using the Likert 5-point scale. Only pediatric gastroenterologists participated in the vote. 

After the vote, the results were discussed in 4 virtual sessions. Statements with over a 75% agreement were approved, and those with less than 75% were removed or reformulated for a second vote. The results of the second vote were further discussed, and rejected statements were put to a third and final vote.

After the third vote, the panel approved 66 statements written into the final paper by the coordinators of each work table. The statements were divided into 8 categories: clinical diagnosis and severity assessment, hepatorenal syndrome, cholangitis, other infections, ascites and peritonitis, hepatic encephalopathy, portal hypertension, and coagulopathy. 

“The main management objective in a child with LC must be to prevent or manage complications,” the authors concluded.

Reference

Flores-Calderón J, Cisneros-Garza LE, Chávez-Barrera JA, et al. Consensus on the management of complications of cirrhosis of the liver in pediatrics. Gastroenterol Mex. Published online May 31, 2022. doi:10.1016/j.rgmx.2022.03.012