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Treatment of Ascites.
Jayanta Choudhury1, Arun J. Sanyal
1Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University Health System, MCV Box 980711, Richmond, VA 23298-0711, USA. ajsanyal@hsc.vcu.edu
Current Treatment Options in Gastroenterology
|October 31, 2003
Summary
Ascites, a common cirrhosis complication, requires management with diuretics or large volume paracentesis (LVP). Refractory ascites indicates poor prognosis, with liver transplantation as the definitive treatment.
Area of Science:
- Hepatology
- Gastroenterology
- Internal Medicine
Background:
- Ascites is the most frequent complication of cirrhosis, affecting over 50% of patients.
- Its development signifies disease progression and is linked to a poor 2-year survival rate of 50%.
- Conventional treatments include sodium restriction, diuretics, and large volume paracentesis (LVP).
Purpose of the Study:
- To review current therapeutic strategies for managing ascites in cirrhosis.
- To discuss the complications and management of diuretic-resistant and refractory ascites.
- To highlight the risks and treatment of spontaneous bacterial peritonitis (SBP).
Main Methods:
- Review of established treatments for ascites, including diuretics and LVP.
- Discussion of refractory ascites management options: LVP, peritoneovenous shunts, and transjugular intrahepatic portosystemic shunts (TIPS).
- Overview of spontaneous bacterial peritonitis (SBP) diagnosis, treatment, and prophylaxis.
Main Results:
- The combination of spironolactone and furosemide is an effective diuretic strategy.
- Large volume paracentesis (LVP) effectively relieves symptoms; intravenous albumin can prevent post-paracentesis circulatory dysfunction (PPCD).
- Refractory ascites has a poor prognosis, with orthotopic liver transplantation as the only definitive therapy.
Conclusions:
- Ascites management requires a stepwise approach, escalating therapy as needed.
- Refractory ascites necessitates consideration of liver transplantation.
- Spontaneous bacterial peritonitis (SBP) is a serious complication requiring prompt treatment and prophylaxis.