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Covid-19 HSE Clinical Guidance and Evidence

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Gastroentrology and Hepatology

Consensus guidance for the care of liver patients during COVID-19 (CD 19-066 001/20.05.20)


  • The National Clinical Programme in Gastroenterology and Hepatology
  • Version 1.0 published March 2020
Background

To help guide Gastroenterology and Hepatology services across the country during the COVID-19 outbreak, the National Clinical Programme in Gastroenterology and Hepatology has prepared specific information and advice. This document provides consensus recommendations from Hepatologists in Ireland for patients and healthcare professionals. In as much as is possible we have linked to the most recent national guidance documents. Please check the HSE Repository for Interim Clinical Guidance intended for the Clinical Community for the latest version of this and all clinical guidance https://hse-ie.libguides.com/Covid19V2. This document was compiled by the Liver Working Group under the auspices of the National Clinical Programme for Gastroenterology and Hepatology and it has been endorsed by the Irish Society of Gastroenterology.

Recommendations

Stable chronic liver disease, compensated cirrhosis and Hepatocellular carcinoma (HCC)

  • Patients should be managed in a virtual setting with telemedicine clinics at appropriate intervals wherever possible.
  • Patients taking immunosuppression (such as azathioprine, prednisolone, mycophenolate, tacrolimus) should continue their medication to avoid a flare of their condition, which would necessitate an increase in immunosuppression.
  • Patients taking immunosuppression (such as liver transplant and autoimmune hepatitis patients) are an at-risk group for COVID-19 and every effort must be taken to avoid unnecessary contact with others, including hospital attendance. Further guidance for vulnerable groups is available on the HPSC website. https://bit.ly/3unkeWG
  • Patients taking antiviral therapy should continue their medication as a flare of their condition could put them at a higher risk of becoming unwell.
  • Prescriptions should be sent out to pharmacies/patients.
  • Treatment for Hepatitis C should not be initiated.
  • Endoscopy for varices surveillance should be deferred in the short term.
  • Liver ultrasound for HCC surveillance should be deferred for three months.
  • All routine in hospital investigations and treatment, such as Fibroscans, liver biopsies, and venesection for Haemochromatosis, should be deferred.
  • Targeted biopsies for the diagnosis of liver cancer should, however, still proceed where necessary.
  • For patients with established HCC, treatment should not be delayed, and surveillance should be maintained wherever possible.

Acutely unwell patients with liver disease and decompensated cirrhosis

  • Patients with new onset jaundice, significantly deranged Liver blood tests (ALT >500), encephalopathy, or large volume ascites must be assessed urgently, ideally in an emergency clinic/non-emergency department setting.
  • Patients with new onset gastrointestinal bleeding (haematemesis/melaena) must be managed through standard emergency care pathways. Endoscopy should be performed with appropriate personal protective equipment. For further information about infection prevention and control guidance for COVID-19 is on the HPSC website.
  • https://www.hpsc.ie/a-z/respiratory/coronavirus/novelcoronavirus/guidance/infectionpreventionandcontrolguidance/
COVID- HEP registry for liver patients
  • The COVID-Hep Registry is a new European registry for patients with chronic liver disease/cirrhosis/liver transplant who have contracted COVID-19. It has been endorsed by the European Association for the Study of the Liver. Please register liver patients after the patient's disease trajectory has become clear i.e. after they have been discharged, recovered or died. www.covid-hep.net
Further information

HSE:

British Association for the Study of the Liver and British Society of Gastroenterology:

British Liver Trust:

America Association for the Study of Liver Diseases:

Health Library Ireland, Health Service Executive. Dr. Steevens' Hospital, Dublin 8. Tel: 01-6352555/8. Email: hli@hse.ie

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