Pathophysiologie und Screening bei Leberzirrhose – State of the Art

Die Diagnose Leberzirrhose impliziert für viele Patienten und Ärzte das irreversible Endstadium chronischer Lebererkrankungen, was aufgrund der enormen therapeutischen Entwicklungen nicht gerechtfertigt ist. Chronische Lebererkrankungen sollten daher heute als Kontinuum betrachtet werden, bei dem Progression und Regression in allen Stadien der Erkrankung möglich sind. Dieses Kontinuum reicht von einfacher Leberzellschädigung über Fibrose bis hin zur Zirrhose. Die Zirrhose kann als Reaktion der Leber auf jede Form der Schädigung auftreten. Die klinische Manifestation der Leberzirrhose wird meist durch stadientypische Komplikationen geprägt, denn die Leberzirrhose selbst verursacht lediglich unspezifische Symptome wie Müdigkeit oder verläuft asymptomatisch. Zur Prävention, Früherkennung und rationalen Behandlung dieser Komplikationen wie Aszites, Ösophagusvarizenblutung, Enzephalopathie oder Leberzellkarzinom bedarf es eines differenzierten Stagings – sowohl in frühen wie auch fortgeschrittenen Stadien der Erkrankung. Ein exaktes Staging der Erkrankung bestimmt auch, ob und welche ätiologische oder symptomatische Therapie bei Patienten mit fortgeschrittener Lebererkrankung begonnen wird. Auch die Wahl des adäquaten Zeitpunktes zur Lebertransplantation wird von diesem Staging bestimmt. Lebensbedrohliche Komplikationen chronischer Lebererkrankungen wie Ösophagusvarizen oder Hepatozelluläre Karzinome sollten frühzeitig erkannt werden, da nur so ein kurativer Therapieansatz möglich ist.

The diagnosis liver cirrhosis implies for many patients and physicians the end stage of a chronic liver disease but this is not justified in the light of the enormous developments in therapy. Accordingly, chronic liver disease should be considered as a continuum in which progression and regression are possible at all stages of the disease. This continuum ranges from simple liver cell damage through fibrosis to cirrhosis. Cirrhosis can occur as the reaction of the liver to any form of damage. The clinical manifestation of liver cirrhosis is usually characterized by stage-typical complications since liver cirrhosis itself only gives rise to unspecific symptoms such as tiredness or has an asymptomatic course. To help in the avoidance, early detection and rational treatment of complications such as ascites, esophageal variceal bleeding, encephalopathy, or hepatocellular carcinoma a differentiated staging is needed – both in the early and advanced stages of the disease. An exact staging of the diseases involves also a comprehensive risk-benefit analysis as to whether and if yes which etiological or symptomatic therapy should be initiated in a patient with advanced liver disease. In addition, the suitable time point for liver transplantation is determined by this staging. Life-threatening complications of chronic liver disease such as esophageal varices or hepatocellular carcinoma should be detected as early as possible since only then is a curative therapeutic option possible.

Key words

complications - management - surveillance - prevention - monitoring

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