Introduction: Prevention of Decompensation Versus Prevention of First Bleeding

Abstract

To better appraise how the field is moving forward and where we are heading, a historical view introduces the spirit of the Baveno consensus workshops. In an era with introduction of effective treatments of the etiological factors, the clinical scenario is changing and the natural history along with it. Novel direct-acting antivirals in hepatitis C is probably just the beginning, and other effective treatments of hepatitis B, NASH, alcohol, and others may follow. This may affect the need of surveillance and clinical follow-up and change the focus. The complex symptomatology and involved organs in chronic liver diseases underline the systemic nature of the diseases. But there is a gap in appropriate care targeted to patients with cirrhosis, and care coordination should be expanded. Integrated care to enable early detection and prevention of decompensation beyond detection of varices and prevention of first variceal bleeding is needed. Thus, early ascites, malnutrition, minimal hepatic encephalopathy, and comorbidities should be within our approach. This introductory section outlines current status, changing scenarios and emerging therapies, and approaches to the patient with early-stage cirrhosis.