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EASL’s Clinical Practice Guidelines assist physicians, healthcare providers, patients and other interested parties in the clinical decision-making process. The EASL Guidelines present a range of state-of-the-art approaches for the diagnosis and treatment of liver diseases.

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2018 | Topic: Liver tumours

Hepatocellular Carcinoma EASL Guidelines

Liver cancer is the fifth most common cancer and the second most frequent cause of cancer-related death globally. Hepato-cellular carcinoma represents about 90% of primary liver cancers and constitutes a major global health problem. The following Clinical Practice Guidelines will give up-to-date advice for the clinical management of patients with hepatocellular carcinoma, as well as providing an in-depth review of all the relevant data leading to the conclusions herein.

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2018 | Topic: Viral hepatitis

Hepatitis E Virus Infection EASL Guideline

Hepatitis E Virus Infection (HEV) is a significant cause of morbidity and mortality, representing an important global health problem. Our understanding of HEV has changed completely over the past decade. Previously, the common thought was that HEV was limited to certain developing countries. We now know that HEV is endemic in most high-income countries and is largely a zoonotic infection. The focus of this Clinical Practice Guideline will be on HEV genotype 3 (and 4). This is due to the paradigm shift in our understanding of zoonotic HEV.  And also because locally acquired HEV is now the commonest cause of acute viral hepatitis in many European countries.

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Hepatitis C virus (HCV) infection is a major cause of chronic liver disease. As a result, worldwide there are approximately 71 million chronically infected individuals. Clinical care for patients with HCV-related liver disease is advancing considerably. Most importantly thanks to an enhanced understanding of the pathophysiology of the disease. And also because of developments in diagnostic procedures and improvements in therapy and prevention. EASL Recommendations on Treatment of Hepatitis C describe the optimal management of patients with acute and chronic HCV infections in 2018 and onwards.

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2018 | Topic: Cirrhosis and complications

Management of Decompensated Cirrhosis EASL Guideline

EASL Guideline on Management of Decompensated Cirrhosis. The natural history of cirrhosis is characterized by an asymptomatic compensated phase followed by a decompensated phase, marked by the development of overt clinical signs, the most frequent of which are ascites, bleeding, encephalopathy, and jaundice. The following Clinical Practice Guidelines (CPGs) represent the first Guideline on the Management of Decompensated Cirrhosis.

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2018 | Topic: Cirrhosis and complications - General hepatology

Nutrition in Chronic Liver Disease EASL Guideline

These EASL Guidelines for Clinical Practice review the present knowledge in the field of Nutrition in Chronic Liver Disease and promote further research on this topic. Screening, assessment and principles of nutritional management are examined, with recommendations provided in specific settings such as hepatic encephalopathy, cirrhotic patients with bone disease, patients undergoing liver surgery or transplantation and critically ill cirrhotic patients.

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2017 | Topic: Viral hepatitis

Hepatitis B EASL Guidelines

EASL Guideline on Hepatitis B. Hepatitis B virus (HBV) infection remains a global public health problem with changing epidemiology due to several factors including vaccination policies and migration. This EASL Clinical Practice Guideline presents updated recommendations for the optimal management of HBV infection. Chronic HBV infection can be classified into five phases: (I) HBeAg-positive chronic infection, (II) HBeAg-positive chronic hepatitis, (III) HBeAg-negative chronic infection, (IV) HBeAg-negative chronic hepatitis and (V) HBsAg-negative phase.

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2017 | Topic: Immune mediated and cholestatic diseases

Role of Endoscopy in Primary Sclerosing Cholangitis

This guideline is an official statement of the European Society of Gastrointestinal Endoscopy (ESGE) and of the European Association for the Study of the Liver (EASL) on primary sclerosing cholangitis. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was adopted to define the strength of recommendations and the quality of evidence.

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2017 | Topic: General hepatology

Acute Liver Failure Guidelines

The term acute liver failure (ALF) is frequently applied as a generic expression to describe patients presenting with or developing an acute episode of liver dysfunction. In the context of hepatological practice, however, ALF refers to a highly specific and rare syndrome. This means an acute abnormality of liver blood tests in an individual without underlying chronic liver disease. The disease process is associated with development of a coagulopathy of liver aetiology, and clinically apparent altered level of consciousness due to hepatic encephalopathy. Several important measures are immediately necessary when the patient presents for medical attention. These, as well as additional clinical procedures will be the subject of the Acute Liver Failure Guidelines.

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2017 | Topic: Immune mediated and cholestatic diseases

Primary Biliary Cholangitis EASL Guideline

Primary biliary cholangitis (PBC) is a chronic inflammatory autoimmune cholestatic liver disease, which when untreated will culminate in end-stage biliary cirrhosis. Diagnosis is usually based on the presence of serum liver tests indicative of a cholestatic hepatitis in association with circulating antimitochondrial antibodies. Patient presentation and course can be diverse and risk stratification is important to ensure all patients receive a personalised approach to their care.

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2016 | Topic: Metabolism, alcohol and toxicity

NAFLD Management EASL Guideline

The Clinical Practice Guidelines propose recommendations for the diagnosis, treatment and follow-up of non-alcoholic fatty liver disease (NAFLD) patients and are the product of a joint effort by the European Association for the Study of the Liver (EASL), European Association for the Study of Diabetes (EASD) and European Association for the Study of Obesity (EASO). They update a position statement based on the 2009 EASL Special Conference. The data have been retrieved by an extensive PubMed search up to April 2015. The final statements are graded according to the level of evidence and strength of recommendation, which are adjustable to local regulations and/or team capacities.

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The first EASL Clinical Practice Guideline on treatment of hepatitis C was published in 1999. Since then, more than 30 EASL Guidelines on various liver diseases have been published. The EASL CPGs are extremely popular in Europe and beyond.  Most importantly, they are a global reference for the current state-of-the-art on diagnosis and management of liver diseases. As consequence, the EASL Guidelines have been widely distributed. And not only by open-access publication in the Journal of Hepatology but also on the EASL website. Finally, for some EASL CPGs, dissemination of knowledge into derivatives of the guidelines (e.g. patient versions).

The Success of the EASL Clinical Practice Guidelines

One possible reason for the success of our guidelines is the streamlined process. This has allowed for a fast response and timely publication of clinical recommendations when there are new developments in a field. This was especially relevant for chronic HCV infection. The rapid development of treatment regimens has prompted the EASL Governing Board to commission regular updates of ‘‘HCV treatment recommendations”on an almost yearly basis since 2014. In 2019, EASL launched The first guideline for hepatitis B. Updated versions for the EASL guidelines for Hepatitis B followed in 2012 and 2017.

EASL acknowledgements

This responsive process of CPG development in almost all areas of hepatology has only been made possible by the commitment of a small team of 5–8 world-leading experts (the ‘‘CPG panel”) and the meticulous evaluation of the CPGs by three independent experts (at least one from outside Europe), as well as the EASL Governing Board. EASL is very grateful for the continuous and outstanding support provided by these experts from our community.

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