Cirrhosis in over 16s: assessment and management—updated summary of NICE guidance

### What you need to know Liver cirrhosis affects 110 people per 100 000 in the UK1 and is closely linked with deprivation. The British Liver Trust2 estimates premature deaths from liver disease to be four times higher in the most deprived areas compared with the most affluent. Early identification and management can delay decompensation events such as variceal bleeding, ascites, and hepatic encephalopathy, leading to longer, better quality life for people with liver disease. In 2015, the National Institute for Health and Care Excellence (NICE) first published guidance on the assessment and early management of cirrhosis in people over 16. This article summarises updated 2023 recommendations, focusing on managing complications, and appraises new evidence related to the effectiveness of non-selective beta blockers (NSBBs) for the primary prevention of decompensation in people with cirrhosis.3 The new guidance also updates recommendations about prevention of variceal bleeding in people with cirrhosis and medium or large oesophageal varices, and the primary prevention of spontaneous bacterial peritonitis in people with cirrhosis and ascites. NICE recommendations are based on systematic reviews of best available evidence and explicit consideration of cost effectiveness. When minimal evidence is available, recommendations are based on the guideline committee’s experience and opinion of what constitutes good practice. Evidence levels for the recommendations are given in italics in square brackets. Definitions of evidence certainty are given in box 1. Box 1 ### GRADE Working Group grades of evidenceRETURN TO TEXT