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Summary for primary care

Cirrhosis in Over 16s: Assessment and Management

Latest Guidance Updates

08 September 2023: updated recommendations on oesophageal varices in the section Monitoring, and minor wording changes. NICE updated information in the section on managing complications, which is not included in this primary care summary.


This Guidelines summary covers the assessment and management of suspected or confirmed cirrhosis in people who are 16 years or older. This summary is intended for use by primary healthcare professionals. Refer to the full guideline for a complete set of recommendations, including managing complications.


For recommendations on diagnosing cirrhosis and reassessing liver disease in people with hepatitis B virus infection, see the section on assessing liver disease in secondary specialist care in the NICE guideline on chronic hepatitis B.


Risk of Complications

  • Refer people who have, or are at high risk of, complications of cirrhosis to a specialist hepatology centre.
  • Calculate the Model for End‑Stage Liver Disease (MELD) score every 6 months for people with compensated cirrhosis.
  • Consider using a MELD score of 12 or more as an indicator that the person is at high risk of complications of cirrhosis.

Hepatocellular Carcinoma

  • Offer ultrasound (with or without measurement of serum alpha‑fetoprotein) every 6 months as surveillance for hepatocellular carcinoma (HCC) for people with cirrhosis who do not have hepatitis B virus infection.
  • Do not offer surveillance for HCC for people who are receiving end of life care.
For people with cirrhosis and hepatitis B virus infection, see the section on surveillance testing for HCC in adults with chronic hepatitis B in the NICE guideline on chronic hepatitis B.

Oesophageal Varices

  • After a diagnosis of cirrhosis, offer the person an upper gastrointestinal endoscopy to detect oesophageal varices unless they are planning to take carvedilol or propranolol to prevent decompensation (see the section on primary prevention of decompensation in the full guideline).
  • Offer surveillance using upper gastrointestinal endoscopy every 3 years to people who: 
    • have already had an endoscopy to detect oesophageal varices, and in whom none have been found and 
    • are not taking carvedilol or propranolol.
  • Consider simultaneous endoscopic variceal band ligation if medium or large varices are detected during upper gastrointestinal endoscopy (see the section on preventing bleeding from medium or large oesophageal varices in the full guideline). 

For recommendations on managing complications, refer to the full guideline.