What are the European Association for the Study of the Liver (EASL) guidelines?

What are EASL Guidelines?

EASL (European Association for the Study of the Liver) guidelines are evidence-based clinical practice recommendations that provide standardized approaches for diagnosing, treating, and managing various liver diseases, developed by expert panels to assist physicians and healthcare providers in clinical decision-making. 1

Purpose and Scope

EASL Clinical Practice Guidelines define the use of diagnostic, therapeutic, and preventive modalities for managing patients with liver diseases 1. These guidelines are intended to:

• Assist physicians, patients, healthcare providers, and health-policy makers in the decision-making process by describing generally accepted approaches based on evidence-based data 1
• Guide clinical practice in circumstances where all possible resources and therapies are available, with the understanding that recommendations should be adapted to local regulations, team capacities, infrastructure, and cost-benefit strategies 1
• Advance research and knowledge of liver diseases to ultimately improve patient care 1

Evidence Grading System

EASL guidelines utilize the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) system to classify evidence quality and recommendation strength 1:

Quality of Evidence:

• High (A): Further research very unlikely to change confidence in the estimated effect 1
• Moderate (B): Further research likely to have important impact on confidence and may change the estimate 1
• Low (C): Further research very likely to have important impact and likely to change the estimate 1

Strength of Recommendations:

• Strong (1): Based on quality of evidence, presumed patient-important outcomes, and costs 1
• Weak (2): Made with less certainty due to variability in preferences and values, or more uncertainty, higher costs, or resource consumption 1

Coverage of Liver Diseases

EASL has published comprehensive guidelines covering major liver conditions:

Cholestatic Liver Diseases

• Primary biliary cirrhosis (PBC) 1
• Primary sclerosing cholangitis (PSC) 1
• PBC-autoimmune hepatitis overlap syndrome 1
• Immunoglobulin G4-associated cholangitis 1

Metabolic Liver Diseases

• Non-alcoholic fatty liver disease (NAFLD) including non-alcoholic fatty liver (NAFL) and non-alcoholic steatohepatitis (NASH), developed jointly with EASD (European Association for the Study of Diabetes) and EASO (European Association for the Study of Obesity) 1

Alcohol-Related Liver Disease

• Alcoholic steatosis, steatohepatitis, and cirrhosis 1
• Management of severe alcoholic hepatitis 1, 2

Hepatocellular Carcinoma

• Surveillance, diagnosis, and therapeutic strategies, developed jointly with EORTC (European Organization for Research and Treatment of Cancer) 1

Hepatic Encephalopathy

• Developed jointly with AASLD (American Association for the Study of Liver Diseases) 1

Other Conditions

• Autoimmune hepatitis 3
• Haemochromatosis 4
• Primary biliary cholangitis 5
• Extrahepatic abdominal surgery in cirrhosis patients 6

Development Process

Expert panels selected by the EASL Governing Board write and discuss guidelines over several months, with independent peer review 1. All contributors must disclose conflicts of interest, which are reviewed by the EASL Ethics Committee to eliminate potential bias 1. Guidelines are based on comprehensive literature searches using PubMed and Cochrane databases up to specified dates 1.

Key Principle

Guidelines are intended to be flexible, in contrast to standards of care which are inflexible policies 1. They suggest preferred approaches to diagnostic, therapeutic, and preventive aspects of care, allowing physicians to adapt recommendations based on individual patient circumstances and available resources 1.