Practical recommendations for the treatment of ascites and its complications

Ascites is one of the earliest and most common complications of patients with cirrhosis, and is associated with complications such as dilutional hyponatraemia, renal dysfunction and spontaneous bacterial peritonitis. The treatment of ascites has been based on the combination of a low-sodium diet and the administration of diuretics. The reintroduction of paracentesis and the recent introduction of the transjugular intrahepatic portosystemic shunt (TIPS) are the most relevant innovations in the treatment of ascites during the past 2 decades. The development of ascites is closely related to renal disturbances of functional origin, including the hepatorenal syndrome. A new definition of hepatorenal syndrome has been proposed recently and 2 different types have been defined (type I or progressive, and type III or stable). Although no effective therapy exists for this syndrome, the use of therapeutic methods (TIPS, vasoconstrictor agents, dialysis) to temporarily improve renal function and act as a 'bridge' to liver transplantation, may be of most benefit. The use of potent and safe antibiotics has improved the resolution rate and survival of patients with spontaneous bacterial peritonitis. In addition, the use of oral antibiotics will simplify the management of this condition in the near future. Finally, prophylactic antibiotic regimens represent a major step forwards in the prevention of spontaneous bacterial peritonitis in subsets of cirrhotic patients with a great risk of developing this complication.