This guideline covers assessing and managing suspected or confirmed cirrhosis in people who are 16 years or older. It aims to improve how cirrhosis is identified and diagnosed, and gives advice on the monitoring, prevention and early management of complications.
In September 2023, we reviewed the evidence and made new or updated recommendations on safe prescribing and use of carvedilol and propranolol in people with cirrhosis, detecting and preventing bleeding from medium or large varices, preventing spontaneous bacterial peritonitis, and primary prevention of decompensation. For more details, see the update information.
The guideline includes recommendations on:
- diagnosing cirrhosis
- monitoring for complications, including hepatocellular carcinoma and oesophageal varices
- managing complications, including decompensation, bleeding from medium or large varices and spontaneous bacterial peritonitis
Who is it for?
- Healthcare professionals caring for people with cirrhosis
- Commissioners and providers of healthcare services
- People with cirrhosis, their families and carers
Guideline development process
The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.
All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.
Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.