Cirrhosis paradigm needs to shift: expert

Wednesday, 30 Sep 2015

Cirrhosis is a heterogeneous disease and not the continuum of a single entity, the conference has heard.

Giving the Bushell lecture at the Opening Plenary of Gastro2015 here in Brisbane Guadelupe Garcia-Tsao from Yale University said the natural history of cirrhosis was a progression across different prognostic stages.

“We talk about individualising therapy but we have to recognise different sub-stages of cirrhosis to figure out the main pathophysiological mechanisms so we can target therapies,” she told delegates.

There’s the view that when a patient gets cirrhosis it’s the end of the road, but the paradigm has to change, she said.

Because cirrhosis consisted of at least two distinct clinical stages — compensated and decompensated.

“When you see a patient with cirrhosis the first question you have to ask yourself is is this patient compensated or decompensated,” she told delegates.

They were two entirely different populations and diseases because they had different survival rates and also different predictors of death.

“If you have entities that have these two differences they have to be treated differently – clinically, in research and in investigations,” she said.

For instance research from Italy showed that patients with compensated disease had a median survival surpassing 12 years, which was reduced to two years for people with decompensated disease.

The treatment approach to each stage was different and depended on the prevailing pathophysiological mechanisms, she told delegates.

“At the early stages you want to remove or reduce cause of damage, and finally when the patient is very sick you want to think of transplant,” she said.

Bushell’s tea has sponsored the lecture for forty years, GESA President Don Cameron told delegates.

He went on to read an attempt made in 1987 to define the many qualities of Bushell lecturer: “The person should be a good communicator and an active and imaginative researcher, an enthusiastic contributor to education activities and above all be adorned with those undefinable characteristics which would allow us to recognise him, or her, as a good bloke or a good bird”.

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