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Refractory Ascites: Pathogenesis, Clinical Impact, and Management.
Fabiolla Siqueira1, Traci Kelly2, Sammy Saab3
1Dr. Siqueira is a resident in the Department of Medicine at Kern Medical Center in Bakersfield, California.
Gastroenterology & Hepatology
|November 15, 2023
Summary
Refractory ascites, a condition unresponsive to standard treatments, presents significant challenges. While liver transplantation offers a cure, procedures like transjugular intrahepatic portosystemic shunts (TIPS) may improve survival rates for patients with this complex condition.
Area of Science:
- Hepatology
- Gastroenterology
- Internal Medicine
Background:
- Refractory ascites is defined by its resistance to diuretic therapy and sodium restriction.
- Current management relies on palliative procedures like large-volume paracentesis and transjugular intrahepatic portosystemic shunts (TIPS).
- These interventions offer temporary symptom relief but are not curative, and patients face a poor prognosis.
Purpose of the Study:
- To review the current understanding of refractory ascites.
- To discuss management strategies and associated complications.
- To highlight the prognostic implications and treatment options.
Main Methods:
- Literature review of refractory ascites management.
- Analysis of complications and survival rates.
- Evaluation of treatment efficacy, including TIPS and liver transplantation.
Main Results:
- Refractory ascites carries a high risk of complications, including spontaneous bacterial peritonitis and hepatorenal syndrome.
- One-year survival rates are approximately 50%, worsening with comorbidities.
- Transjugular intrahepatic portosystemic shunts (TIPS) have shown potential to increase survival, alongside liver transplantation as the only curative option.
Conclusions:
- Refractory ascites is a severe condition with limited therapeutic options beyond procedural interventions.
- Prognosis is poor, emphasizing the need for effective management strategies.
- Liver transplantation remains the definitive cure, while TIPS may offer survival benefits.
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