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Ascites.

Nelson Garcia1, Arun J. Sanyal

  • 1Division of Gastroenterology, Hepatology, and Nutrition, Medical College of Virginia-Virginia Commonwealth University, 1101 East Marshall Street, PO Box 980711, Richmond, VA 23298-0711, USA. ajsanyal@hsc.vcu

Current Treatment Options in Gastroenterology
|November 7, 2001
PubMed
Summary

Ascites management in decompensated cirrhosis involves diuretics and large-volume paracentesis (LVP). Refractory ascites has poor prognosis, with transjugular intrahepatic portasystemic shunts (TIPS) showing promise but requiring careful patient selection.

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Area of Science:

  • Hepatology
  • Gastroenterology
  • Internal Medicine

Background:

  • Ascites is a common complication of decompensated cirrhosis, significantly impacting prognosis.
  • Effective management is crucial, with first-line therapies including sodium restriction, diuretics, and large-volume paracentesis (LVP).
  • Refractory ascites presents a dire prognosis, often necessitating advanced interventions.

Purpose of the Study:

  • To review current therapeutic strategies for ascites in decompensated cirrhosis.
  • To evaluate the efficacy and limitations of various treatment options, including LVP and transjugular intrahepatic portasystemic shunts (TIPS).
  • To discuss the management of spontaneous bacterial peritonitis (SBP), a common complication.

Main Methods:

  • Review of established guidelines and recent literature on ascites management.
  • Analysis of therapeutic outcomes for LVP, peritoneovenous shunts, and TIPS.
  • Discussion of pharmacological approaches for ascites and SBP prophylaxis and treatment.

Main Results:

  • First-line therapy includes sodium restriction, diuretics (loop and distal), and LVP.
  • LVP provides rapid symptom relief but ascites recurs; albumin administration is recommended for large-volume fluid removal.
  • Transjugular intrahepatic portasystemic shunts (TIPS) can be effective for refractory ascites, particularly with preserved liver function, but survival benefits are not definitively established.
  • Spontaneous bacterial peritonitis (SBP) is a frequent complication with high mortality; prophylaxis and prompt treatment with antibiotics are vital.

Conclusions:

  • Ascites management requires a multi-faceted approach tailored to patient status.
  • Transjugular intrahepatic portasystemic shunts (TIPS) offer a therapeutic option for refractory ascites but require careful consideration of liver function.
  • Prompt recognition and treatment of spontaneous bacterial peritonitis are critical for improving outcomes in cirrhotic patients with ascites.

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