The diagnosis and management of portal hypertension in cirrhosis: The Gastroenterological Society of Australia consensus

BACKGROUND: In Australia, chronic liver disease is now the third leading cause of premature death in people aged 50-59 years, and the fourth leading cause in all other 5-year age groups from 35 to 70 years in Australia. A consensus statement on the diagnosis and management of portal hypertension in patients with cirrhosis was developed by the Gastroenterological Society of Australia (GESA), the peak national organization for health care professionals and researchers working in gastroenterology and hepatology, to provide contemporary, evidence-based clinical guidelines. A summary of its recommendations is presented here. METHODS: The consensus statement was developed in accordance with the Appraisal of Guidelines for Research and Evaluation II instrument and the 2016 National Health and Medical Research Council Standards for Guidelines. A panel of 46 health care professionals with expertise in managing portal hypertension participated in the development of the consensus statement. The consensus development conference method was used to determine consensus for each recommendation, with a hybrid face-to-face and online meeting held in Noosa, Australia, on 3 August 2024, followed by 2 online meetings. RESULTS: A total of 52 recommendations were approved by the consensus development group without dissent across the following domains: (1) diagnosis, risk stratification, and prevention of decompensation; (2) portal hypertension-related bleeding; (3) ascites and renal impairment; (4) hepatic encephalopathy; (5) sarcopenia, nutrition, and frailty; (6) thrombosis in cirrhosis; (7) cardiopulmonary complications; (8) surgery and portal hypertension; and (9) pregnancy and portal hypertension. DISCUSSION: This is the first Australian consensus statement on the diagnosis and management of portal hypertension in patients with cirrhosis. The recommendations in this summary document provide standardized clinical guidance with the goal of improving outcomes for patients with cirrhosis and portal hypertension in Australia.