Primary biliary cirrhosis natural history, complications and prognosis: Difference between revisions

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{{Primary biliary cirrhosis}}
{{Primary biliary cirrhosis}}


{{CMG}}; {{AE}}
{{CMG}}; {{AE}} {{AA}}, {{Anmol}}


==Overview==
==Overview==
If left untreated, [#]% of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].
The symptoms of primary biliary cirrhosis usually develop in the fourth and fifth decade of life and start with symptoms such as [[fatigue]] and [[pruritis]]. If left untreated, patients with primary biliary cirrhosis may progress to develop an advanced stage of [[Fibrosis|liver fibrosis]] and its subsequent complications such as [[portal hypertension]] and [[liver failure]]. Patients with untreated primary biliary cirrhosis have an increased the incidence of [[hepatocellular carcinoma]]. Prognosis of the disease is generally good with the mild disease and early treatment with [[ursodeoxycholic acid]].


OR
Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].
OR
Prognosis is generally excellent/good/poor, and the 1/5/10-year mortality/survival rate of patients with [disease name] is approximately [#]%.
==Natural History, Complications, and Prognosis==
==Natural History, Complications, and Prognosis==


===Natural History===
===Natural History===
*The symptoms of (disease name) usually develop in the first/ second/ third decade of life, and start with symptoms such as ___.  
*The symptoms of primary biliary cirrhosis usually develop in the fourth and fifth decade of life and start with symptoms such as [[fatigue]] and [[pruritis]].<ref name="pmid21529926">{{cite journal| author=Selmi C, Bowlus CL, Gershwin ME, Coppel RL| title=Primary biliary cirrhosis. | journal=Lancet | year= 2011 | volume= 377 | issue= 9777 | pages= 1600-9 | pmid=21529926 | doi=10.1016/S0140-6736(10)61965-4 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21529926  }} </ref><ref name="pmid9362353">{{cite journal| author=Jones DE, Metcalf JV, Collier JD, Bassendine MF, James OF| title=Hepatocellular carcinoma in primary biliary cirrhosis and its impact on outcomes. | journal=Hepatology | year= 1997 | volume= 26 | issue= 5 | pages= 1138-42 | pmid=9362353 | doi=10.1002/hep.510260508 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9362353  }} </ref><ref name="pmid22504852">{{cite journal| author=Liang Y, Yang Z, Zhong R| title=Primary biliary cirrhosis and cancer risk: a systematic review and meta-analysis. | journal=Hepatology | year= 2012 | volume= 56 | issue= 4 | pages= 1409-17 | pmid=22504852 | doi=10.1002/hep.25788 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22504852  }} </ref>
*The symptoms of (disease name) typically develop ___ years after exposure to ___.  
*If left untreated, patients with primary biliary cirrhosis may progress to develop advanced stage of liver fibrosis and its subsequent complications such as [[portal hypertension]] and [[liver failure]].
*If left untreated, [#]% of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].
*Patients with untreated primary biliary cirrhosis have increased the incidence of [[hepatocellular carcinoma]].


===Complications===
===Complications===
*Common complications of [disease name] include:
*Common complications of primary biliary cirrhosis include:<ref name="pmid21529926">{{cite journal| author=Selmi C, Bowlus CL, Gershwin ME, Coppel RL| title=Primary biliary cirrhosis. | journal=Lancet | year= 2011 | volume= 377 | issue= 9777 | pages= 1600-9 | pmid=21529926 | doi=10.1016/S0140-6736(10)61965-4 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21529926  }} </ref><ref name="pmid9362353">{{cite journal| author=Jones DE, Metcalf JV, Collier JD, Bassendine MF, James OF| title=Hepatocellular carcinoma in primary biliary cirrhosis and its impact on outcomes. | journal=Hepatology | year= 1997 | volume= 26 | issue= 5 | pages= 1138-42 | pmid=9362353 | doi=10.1002/hep.510260508 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9362353  }} </ref><ref name="pmid22504852">{{cite journal| author=Liang Y, Yang Z, Zhong R| title=Primary biliary cirrhosis and cancer risk: a systematic review and meta-analysis. | journal=Hepatology | year= 2012 | volume= 56 | issue= 4 | pages= 1409-17 | pmid=22504852 | doi=10.1002/hep.25788 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22504852  }} </ref><ref name="pmid18456188">{{cite journal| author=Parés A, Guañabens N| title=Osteoporosis in primary biliary cirrhosis: pathogenesis and treatment. | journal=Clin Liver Dis | year= 2008 | volume= 12 | issue= 2 | pages= 407-24; x | pmid=18456188 | doi=10.1016/j.cld.2008.02.005 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18456188  }} </ref><ref name="pmid11569705">{{cite journal| author=Phillips JR, Angulo P, Petterson T, Lindor KD| title=Fat-soluble vitamin levels in patients with primary biliary cirrhosis. | journal=Am J Gastroenterol | year= 2001 | volume= 96 | issue= 9 | pages= 2745-50 | pmid=11569705 | doi=10.1111/j.1572-0241.2001.04134.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11569705  }} </ref><ref name="pmid19554543">{{cite journal| author=Lindor KD, Gershwin ME, Poupon R, Kaplan M, Bergasa NV, Heathcote EJ et al.| title=Primary biliary cirrhosis. | journal=Hepatology | year= 2009 | volume= 50 | issue= 1 | pages= 291-308 | pmid=19554543 | doi=10.1002/hep.22906 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19554543  }} </ref><ref name="BlacharFederle2001">{{cite journal|last1=Blachar|first1=Arye|last2=Federle|first2=Michael P.|last3=Brancatelli|first3=Giuseppe|title=Primary Biliary Cirrhosis: Clinical, Pathologic, and Helical CT Findings in 53 Patients|journal=Radiology|volume=220|issue=2|year=2001|pages=329–336|issn=0033-8419|doi=10.1148/radiology.220.2.r01au36329}}</ref>
**[complication 1]
**[[Cirrhosis]]
**[complication 2]
**[[Hepatocellular carcinoma]]
**[complication 3]
**[[Portal hypertension]]
**[[Liver failure]]
**[[Hepatic encephalopathy]]
**[[Varices]]
**[[Osteoporosis]]
**[[Malabsorption]]
**[[Fat soluble vitamins|Fat soluble vitamin]] deficiency ([[Vitamin A deficiency|Vitamin A]], [[Vitamin D deficiency|D]], [[Vitamin E deficiency|E]], [[Vitamin K deficiency|K]])


===Prognosis===
===Prognosis===
Prognosis is generally good with the mild disease and early treatment with Ursodeoxycholic acid. Factors associated with poor prognosis include: <ref name="pmid7930469">{{cite journal| author=Mahl TC, Shockcor W, Boyer JL| title=Primary biliary cirrhosis: survival of a large cohort of symptomatic and asymptomatic patients followed for 24 years. | journal=J Hepatol | year= 1994 | volume= 20 | issue= 6 | pages= 707-13 | pmid=7930469 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7930469  }} </ref> <ref name="pmid9934730">{{cite journal| author=Springer J, Cauch-Dudek K, O'Rourke K, Wanless IR, Heathcote EJ| title=Asymptomatic primary biliary cirrhosis: a study of its natural history and prognosis. | journal=Am J Gastroenterol | year= 1999 | volume= 94 | issue= 1 | pages= 47-53 | pmid=9934730 | doi=10.1111/j.1572-0241.1999.00770.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9934730  }} </ref><ref name="pmid20800924">{{cite journal| author=Jones DE, Al-Rifai A, Frith J, Patanwala I, Newton JL| title=The independent effects of fatigue and UDCA therapy on mortality in primary biliary cirrhosis: results of a 9 year follow-up. | journal=J Hepatol | year= 2010 | volume= 53 | issue= 5 | pages= 911-7 | pmid=20800924 | doi=10.1016/j.jhep.2010.05.026 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20800924  }} </ref><ref name="pmid25160979">{{cite journal| author=Lammers WJ, van Buuren HR, Hirschfield GM, Janssen HL, Invernizzi P, Mason AL et al.| title=Levels of alkaline phosphatase and bilirubin are surrogate end points of outcomes of patients with primary biliary cirrhosis: an international follow-up study. | journal=Gastroenterology | year= 2014 | volume= 147 | issue= 6 | pages= 1338-49.e5; quiz e15 | pmid=25160979 | doi=10.1053/j.gastro.2014.08.029 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25160979  }} </ref><ref name="pmid9362353">{{cite journal| author=Jones DE, Metcalf JV, Collier JD, Bassendine MF, James OF| title=Hepatocellular carcinoma in primary biliary cirrhosis and its impact on outcomes. | journal=Hepatology | year= 1997 | volume= 26 | issue= 5 | pages= 1138-42 | pmid=9362353 | doi=10.1002/hep.510260508 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9362353  }} </ref><ref name="pmid17187436">{{cite journal| author=Nakamura M, Kondo H, Mori T, Komori A, Matsuyama M, Ito M et al.| title=Anti-gp210 and anti-centromere antibodies are different risk factors for the progression of primary biliary cirrhosis. | journal=Hepatology | year= 2007 | volume= 45 | issue= 1 | pages= 118-27 | pmid=17187436 | doi=10.1002/hep.21472 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17187436  }} </ref><ref name="pmid18930330">{{cite journal| author=Poupon R, Ping C, Chrétien Y, Corpechot C, Chazouillères O, Simon T et al.| title=Genetic factors of susceptibility and of severity in primary biliary cirrhosis. | journal=J Hepatol | year= 2008 | volume= 49 | issue= 6 | pages= 1038-45 | pmid=18930330 | doi=10.1016/j.jhep.2008.07.027 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18930330  }} </ref><ref name="pmid21703179">{{cite journal| author=Corpechot C, Gaouar F, Chrétien Y, Johanet C, Chazouillères O, Poupon R| title=Smoking as an independent risk factor of liver fibrosis in primary biliary cirrhosis. | journal=J Hepatol | year= 2012 | volume= 56 | issue= 1 | pages= 218-24 | pmid=21703179 | doi=10.1016/j.jhep.2011.03.031 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21703179  }} </ref>
Prognosis is generally good with the mild disease and early treatment with [[ursodeoxycholic acid]]. Factors associated with poor prognosis include: <ref name="pmid9934730">{{cite journal| author=Springer J, Cauch-Dudek K, O'Rourke K, Wanless IR, Heathcote EJ| title=Asymptomatic primary biliary cirrhosis: a study of its natural history and prognosis. | journal=Am J Gastroenterol | year= 1999 | volume= 94 | issue= 1 | pages= 47-53 | pmid=9934730 | doi=10.1111/j.1572-0241.1999.00770.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9934730  }} </ref><ref name="pmid20800924">{{cite journal| author=Jones DE, Al-Rifai A, Frith J, Patanwala I, Newton JL| title=The independent effects of fatigue and UDCA therapy on mortality in primary biliary cirrhosis: results of a 9 year follow-up. | journal=J Hepatol | year= 2010 | volume= 53 | issue= 5 | pages= 911-7 | pmid=20800924 | doi=10.1016/j.jhep.2010.05.026 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20800924  }} </ref><ref name="pmid25160979">{{cite journal| author=Lammers WJ, van Buuren HR, Hirschfield GM, Janssen HL, Invernizzi P, Mason AL et al.| title=Levels of alkaline phosphatase and bilirubin are surrogate end points of outcomes of patients with primary biliary cirrhosis: an international follow-up study. | journal=Gastroenterology | year= 2014 | volume= 147 | issue= 6 | pages= 1338-49.e5; quiz e15 | pmid=25160979 | doi=10.1053/j.gastro.2014.08.029 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25160979  }} </ref><ref name="pmid9362353">{{cite journal| author=Jones DE, Metcalf JV, Collier JD, Bassendine MF, James OF| title=Hepatocellular carcinoma in primary biliary cirrhosis and its impact on outcomes. | journal=Hepatology | year= 1997 | volume= 26 | issue= 5 | pages= 1138-42 | pmid=9362353 | doi=10.1002/hep.510260508 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9362353  }} </ref><ref name="pmid17187436">{{cite journal| author=Nakamura M, Kondo H, Mori T, Komori A, Matsuyama M, Ito M et al.| title=Anti-gp210 and anti-centromere antibodies are different risk factors for the progression of primary biliary cirrhosis. | journal=Hepatology | year= 2007 | volume= 45 | issue= 1 | pages= 118-27 | pmid=17187436 | doi=10.1002/hep.21472 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17187436  }} </ref><ref name="pmid18930330">{{cite journal| author=Poupon R, Ping C, Chrétien Y, Corpechot C, Chazouillères O, Simon T et al.| title=Genetic factors of susceptibility and of severity in primary biliary cirrhosis. | journal=J Hepatol | year= 2008 | volume= 49 | issue= 6 | pages= 1038-45 | pmid=18930330 | doi=10.1016/j.jhep.2008.07.027 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18930330  }} </ref><ref name="pmid21703179">{{cite journal| author=Corpechot C, Gaouar F, Chrétien Y, Johanet C, Chazouillères O, Poupon R| title=Smoking as an independent risk factor of liver fibrosis in primary biliary cirrhosis. | journal=J Hepatol | year= 2012 | volume= 56 | issue= 1 | pages= 218-24 | pmid=21703179 | doi=10.1016/j.jhep.2011.03.031 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21703179  }} </ref>
*Advanced disease
*Advanced disease
*Co existing autoimmune disorders such as Sicca syndrome, thyroiditis, and scleroderma
*Co existing [[Autoimmune disease|autoimmune]] disorders such as [[sicca syndrome]], [[thyroiditis]], and [[scleroderma]]
*Symptomatic disease
*Symptomatic disease
*Increased levels of Alkaline PO4ase and bilirubin levels at the time of diagnosis
*Increased levels of [[alkaline phosphatase]] and [[bilirubin]] levels at the time of diagnosis
*Stage III and IV disease on histological examination  
*Stage III and IV disease on histological examination  
*Presence of Antinuclear antibodies( antiGp210, antiSp100)
*Presence of [[antinuclear antibodies]] (antiGp210, antiSp100)
*Cigarette Smoking
*[[Cigarette smoking]]
*Genetic polymporphism
*[[Genetic]] polymporphism


==References==
==References==
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{{WH}}
{{WH}}
{{WS}}
{{WS}}
[[Category:Gastroenterology]]
[[Category:Hepatology]]
[[Category:Disease]]
[[Category:Rheumatology]]
[[Category:Medicine]]
[[Category:Up-To-Date]]

Latest revision as of 23:49, 29 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aysha Anwar, M.B.B.S[2], Anmol Pitliya, M.B.B.S. M.D.[3]

Overview

The symptoms of primary biliary cirrhosis usually develop in the fourth and fifth decade of life and start with symptoms such as fatigue and pruritis. If left untreated, patients with primary biliary cirrhosis may progress to develop an advanced stage of liver fibrosis and its subsequent complications such as portal hypertension and liver failure. Patients with untreated primary biliary cirrhosis have an increased the incidence of hepatocellular carcinoma. Prognosis of the disease is generally good with the mild disease and early treatment with ursodeoxycholic acid.

Natural History, Complications, and Prognosis

Natural History

  • The symptoms of primary biliary cirrhosis usually develop in the fourth and fifth decade of life and start with symptoms such as fatigue and pruritis.[1][2][3]
  • If left untreated, patients with primary biliary cirrhosis may progress to develop advanced stage of liver fibrosis and its subsequent complications such as portal hypertension and liver failure.
  • Patients with untreated primary biliary cirrhosis have increased the incidence of hepatocellular carcinoma.

Complications

Prognosis

Prognosis is generally good with the mild disease and early treatment with ursodeoxycholic acid. Factors associated with poor prognosis include: [8][9][10][2][11][12][13]

References

  1. ↑ 1.0 1.1 Selmi C, Bowlus CL, Gershwin ME, Coppel RL (2011). "Primary biliary cirrhosis". Lancet. 377 (9777): 1600–9. doi:10.1016/S0140-6736(10)61965-4. PMID 21529926.
  2. ↑ 2.0 2.1 2.2 Jones DE, Metcalf JV, Collier JD, Bassendine MF, James OF (1997). "Hepatocellular carcinoma in primary biliary cirrhosis and its impact on outcomes". Hepatology. 26 (5): 1138–42. doi:10.1002/hep.510260508. PMID 9362353.
  3. ↑ 3.0 3.1 Liang Y, Yang Z, Zhong R (2012). "Primary biliary cirrhosis and cancer risk: a systematic review and meta-analysis". Hepatology. 56 (4): 1409–17. doi:10.1002/hep.25788. PMID 22504852.
  4. ↑ Parés A, Guañabens N (2008). "Osteoporosis in primary biliary cirrhosis: pathogenesis and treatment". Clin Liver Dis. 12 (2): 407–24, x. doi:10.1016/j.cld.2008.02.005. PMID 18456188.
  5. ↑ Phillips JR, Angulo P, Petterson T, Lindor KD (2001). "Fat-soluble vitamin levels in patients with primary biliary cirrhosis". Am J Gastroenterol. 96 (9): 2745–50. doi:10.1111/j.1572-0241.2001.04134.x. PMID 11569705.
  6. ↑ Lindor KD, Gershwin ME, Poupon R, Kaplan M, Bergasa NV, Heathcote EJ; et al. (2009). "Primary biliary cirrhosis". Hepatology. 50 (1): 291–308. doi:10.1002/hep.22906. PMID 19554543.
  7. ↑ Blachar, Arye; Federle, Michael P.; Brancatelli, Giuseppe (2001). "Primary Biliary Cirrhosis: Clinical, Pathologic, and Helical CT Findings in 53 Patients". Radiology. 220 (2): 329–336. doi:10.1148/radiology.220.2.r01au36329. ISSN 0033-8419.
  8. ↑ Springer J, Cauch-Dudek K, O'Rourke K, Wanless IR, Heathcote EJ (1999). "Asymptomatic primary biliary cirrhosis: a study of its natural history and prognosis". Am J Gastroenterol. 94 (1): 47–53. doi:10.1111/j.1572-0241.1999.00770.x. PMID 9934730.
  9. ↑ Jones DE, Al-Rifai A, Frith J, Patanwala I, Newton JL (2010). "The independent effects of fatigue and UDCA therapy on mortality in primary biliary cirrhosis: results of a 9 year follow-up". J Hepatol. 53 (5): 911–7. doi:10.1016/j.jhep.2010.05.026. PMID 20800924.
  10. ↑ Lammers WJ, van Buuren HR, Hirschfield GM, Janssen HL, Invernizzi P, Mason AL; et al. (2014). "Levels of alkaline phosphatase and bilirubin are surrogate end points of outcomes of patients with primary biliary cirrhosis: an international follow-up study". Gastroenterology. 147 (6): 1338–49.e5, quiz e15. doi:10.1053/j.gastro.2014.08.029. PMID 25160979.
  11. ↑ Nakamura M, Kondo H, Mori T, Komori A, Matsuyama M, Ito M; et al. (2007). "Anti-gp210 and anti-centromere antibodies are different risk factors for the progression of primary biliary cirrhosis". Hepatology. 45 (1): 118–27. doi:10.1002/hep.21472. PMID 17187436.
  12. ↑ Poupon R, Ping C, Chrétien Y, Corpechot C, Chazouillères O, Simon T; et al. (2008). "Genetic factors of susceptibility and of severity in primary biliary cirrhosis". J Hepatol. 49 (6): 1038–45. doi:10.1016/j.jhep.2008.07.027. PMID 18930330.
  13. ↑ Corpechot C, Gaouar F, Chrétien Y, Johanet C, Chazouillères O, Poupon R (2012). "Smoking as an independent risk factor of liver fibrosis in primary biliary cirrhosis". J Hepatol. 56 (1): 218–24. doi:10.1016/j.jhep.2011.03.031. PMID 21703179.

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