Report of the Baveno VI Consensus Workshop.

The latest update of the Baveno consensus was held on April 10-11 of 2015 in Baveno, Italy. The meeting led by Professor Robert deFranchis started in 1986 and has been held approximately every 5 years with a publication following each meeting. This latest Baveno VI workshop was attended by the “who is who” in world of portal hypertension; mainly experts responsible for most data produced in the last decade. The goals of these meetings are to develop and update definitions of key events and concepts in portal hypertension. The proceedings of these meetings are considered by most Hepatologists the quintessential guidelines in portal hypertension. Since they are organized under the auspices of EASL they are therefore considered the EASL guidelines of portal hypertension. Other guidelines from the United States (AASLD), Asia (APASL) and the UK are also very popular, but do not use the format of the Baveno guidelines. A key issue of this consensus is that is it constantly evolving over prior definitions. In all meetings the experts review the evidence on the natural history, the diagnosis and the management of portal hypertension and make evidence-based recommendations not only on these topics but also recommend research agendas in the field. All these meetings are highly successful and produce a consensus statement on almost aspects related to portal hypertension in adults and children. As always not all topics are settled and several points remain unsettled due to lack of proper studies. This last meeting not only focused on all issues of natural history, diagnosis and management but also introduced new concepts. An important one was related to the different stages of cirrhosis and the different risks of developing complications and of dying. In fact the meeting was entitled “Stratifying risk and individualizing care for portal hypertension”. There were discussions on invasive and non-invasive methods for diagnosing varices and portal hypertension, the role and impact of the underlying etiology of cirrhosis was discussed mainly in relation to new hepatitis C therapies , the primary prevention of decompensation, the management of the acute bleeding episode, the prevention of recurrent bleeding and other decompensating events, and vascular diseases of the liver in cirrhotic and non-cirrhotic patients. All areas were assigned a group of experts (around 6-10) and they issued a number of statements that were then discussed among the audience and agreed upon. An important concept that was introduced was that of compensated advanced chronic liver disease (cACLD). This was term was proposed in order to illustrate that the range of severe fibrosis and cirrhosis may occur in a continuous fashion and teasing them apart is not easy relying only on clinical data. A clearer role of transient elastography (TE) was introduced and we now know that TE allows the early identification of patients with chronic liver disease who may develop clinically significant portal hypertension. In fact liver stiffness measured by TE is adequate to suspect cACLD. TE values 15 kPa then this is very indicative of cACLD. If needed the diagnosis of cACLD can be confirmed with liver biopsy, hepatic venous pressure gradient (HVPG), or upper endoscopy. HVPG measurement is still considered the gold-standard method to define clinically significant portal hypertension (values > 10 mmHg). These patients do not have varices or ascites but should be monitored closely. The issue regarding the avoidance of screening endoscopy was also brought up and new information The Official Journal of the Mexican Association of Hepatology, the Latin-American Association for Study of the Liver and the Canadian Association for the Study of the Liver