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Noninvasive approaches to the assessment of fibrosis are now preferred, with liver biopsy reserved when results of noninvasive testing are inconclusive. The FIB-4 score is often used particularly to exclude advanced fibrosis because of its simplicity. It is based on age, platelet count, and serum AST and ALT levels.

Younossi ZM et al. Am J Gastroenterol. [PMID: 33284184]


In patients with clinically significant portal hypertension, carvedilol, a nonselective beta receptor antagonist with alpha-1 blocking activity, appears to reduce the frequency of decompensating events, although it may lead to hypotension particularly in patients with decompensated cirrhosis.

Tandon P et al. Clin Gastroenterol Hepatol. [PMID: 33221550]

Vancomycin should be added in patients with prior bacterial peritonitis or a positive surveillance swab for methicillin-resistant Staphylococcus aureus. Daptomycin should be added in patients with a positive surveillance swab for vancomycin-resistant enterococcus. Meropenem can be used in patients with current or recent exposure to piperacillin-tazobactam.

Biggins SW et al. Hepatology. [PMID: 33942342]


Obeticholic acid, a farnesoid X receptor agonist, can cause serious liver injury in patients with advanced cirrhosis, and its use in these patients has been restricted by the FDA.

Lleo A et al. Lancet. [PMID: 33308474]


Serum biomarkers of fibrosis may be an alternative to liver biopsy for identifying advanced fibrosis.

Chin J et al. Clin Gastroenterol Hepatol. [PMID: 32745684]

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