Abstract:
The European Association for the Study of the Liver (EASL) has recently (June 2022) produced new clinical practice guidelines for the investigation and management of haemochromatosis, to replace the previous document published in 2010. Here, we provide an overview of the principal changes recommended for the investigation and management of haemochromatosis arising from these guidelines and highlight particular areas where evidence is lacking and where future focus on specific research would improve patient treatment and outcomes. The guideline provides several important new recommendations that will have a meaningful impact on patient management. Specifically, the use of hepatic elastography as a non-invasive assessment of fibrosis, erythrocytapheresis as an alternative treatment modality to classical phlebotomy, surveillance for hepatocellular carcinoma, dietary recommendations in patients with haemochromatosis and guidance on controversial topics including the management of P.C282Y/p.H63D compound heterozygotes, which have been a source of controversy within the field. It is anticipated that the new guidance will affect the management of haemochromatosis patients commonly seen in gastroenterology, liver and related clinics (e.g. haematology and rheumatology) and with this publication we intend to highlight these changes so as to empower clinicians with the confidence to bring these improvements to their translational practice in the treatment of these patients.
摘要:
欧洲肝脏研究协会(EASL)最近(2022年6月)为血色素沉着病的研究和管理制定了新的临床实践指南。以取代2010年发布的上一份文件。这里,我们概述了这些指南中建议的血色病调查和治疗的主要变化,并重点介绍了缺乏证据的特定领域,以及未来对特定研究的关注将改善患者的治疗和结局.该指南提供了一些重要的新建议,将对患者管理产生有意义的影响。具体来说,使用肝弹性成像作为纤维化的非侵入性评估,红细胞置换作为经典静脉切开术的替代治疗方式,监测肝细胞癌,血色素沉着症患者的饮食建议和关于有争议主题的指导,包括P.C282Y/p的管理。H63D复合杂合子,这一直是该领域争议的根源。预计新指南将影响胃肠病学中常见的血色素沉着症患者的管理,肝脏和相关诊所(例如血液学和风湿病学),我们打算在本出版物中强调这些变化,以便使临床医生有信心将这些改进带到他们治疗这些患者的转化实践中。