Preventive care in chronic liver disease

OBJECTIVE: To identify preventive care measures that are appropriate for an d specific to patients with chronic liver disease and to provide recommenda tions and information that can be shared with patients, MEASUREMENTS: A review of the literature was undertaken using MEDLINE from 1970 to present. Priority was given to randomized controlled studies, but c ase reports, case-control studies, and reviews were included. MAIN RESULTS: Evidence for the avoidance of alcohol and other toxic substan ces, immunizations, and dietary modifications for chronic liver disease is summarized. In addition, measures that are effective In the mitigation of t he complications of cirrhosis are reviewed. CONCLUSIONS: Preventive care can play an important role in patients with ch ronic liver diseases. Based on the existing data, the preventive strategies of alcohol avoidance, hepatitis vaccination, avoidance of NSAIDs nonsteroi dal anti-inflammatory drags, iron supplementation when appropriate, and a l ow-fat diet are prudent in patients with chronic liver disease. Once cirrho sis develops, screening for hepatocellular cancer with a-fetoprotein testin g and ultrasound, and screening for varices by endoscopy are justified.