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Chronic Liver Disease in the Older Patient—Evaluation and Management

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Abstract

Purpose of Review

As our population ages, the number of elderly patients with advanced chronic liver disease (ACLD) will increase. In this review we explore risk factors for liver injury, noninvasive assessment of liver disease, complications of cirrhosis, and management of frailty and sarcopenia in the older patient with ACLD.

Recent Findings

Multiple guidelines regarding ACLD have been updated over the past few years. New cutoffs for FIB-4 and NAFLD (MASLD – Metabolic Dysfunction Associated Steatotic Liver Disease) fibrosis scores for elderly patients are being validated. Older patients with MASLD benefit from caloric restriction, exercise programs, and GLP-1 agonists. Patients with ACLD need to be screened for alcohol use disorder with modified scoring systems, and if positive, benefit from referral to chemical dependency programs. Carvedilol and diuretics may safely be used in the elderly for portal hypertension and ascites, respectively, with careful monitoring. Malnutrition, frailty, sarcopenia, and bone mineral disease are common in older patients with ACLD, and early intervention may improve outcomes.

Summary

Early identification of ACLD in elderly patients allows us to manage risk factors for liver injury, screen for complications, and implement lifestyle and pharmacological therapy to reduce decompensation and death. Future studies may clarify the role of noninvasive imaging in assessing liver fibrosis in the elderly and optimal interventions for nutrition, frailty, sarcopenia, bone health in addition to reevaluation of antibiotic prophylaxis for liver conditions with rising antibiotic resistance.

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Authors and Affiliations

  1. Department of Gastroenterology, Brooklyn Campus of the Veterans Affairs New York Harbor Healthcare System, 800 Poly Pl, Brooklyn, NY, 11209, USA

    Daniel Anthony DiLeo & Ayse Aytaman

  2. Department of Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY, 11203, USA

    Tolga Gidener

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Daniel DiLeo wrote and edited the manuscript. Daniel DiLeo approves the final draft submitted. Tolga Gidener wrote sections of the manuscript, created tables, and edited the manuscript. Tolga Gidener approves the final draft submitted. Ayse Aytaman conceived the design of this review and edited the manuscript. Ayse Aytaman approves the final draft submitted.

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DiLeo, D.A., Gidener, T. & Aytaman, A. Chronic Liver Disease in the Older Patient—Evaluation and Management. Curr Gastroenterol Rep 25, 390–400 (2023). https://doi.org/10.1007/s11894-023-00908-2

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