Current approaches to the management of patients with cirrhotic ascites

World J Gastroenterol. 2019 Jul 28;25(28):3738-3752. doi: 10.3748/wjg.v25.i28.3738.

Abstract

This review describes current approaches to the management of patients with cirrhotic ascites in relation to the severity of its clinical manifestations. The PubMed database, the Google Scholar retrieval system, the Cochrane Database of Systematic Reviews, and the reference lists from related articles were used to search for relevant publications. Articles corresponding to the aim of the review were selected for 1991-2018 using the keywords: "liver cirrhosis," "portal hypertension," "ascites," "pathogenesis," "diagnostics," and "treatment." Uncomplicated and refractory ascites in patients with cirrhosis were the inclusion criteria. The literature analysis has shown that despite the achievements of modern hepatology, the presence of ascites is associated with poor prognosis and high mortality. The key to successful management of patients with ascites may be the stratification of the risk of an adverse outcome and personalized therapy. Pathogenetically based approach to the choice of pharmacotherapy and optimization of minimally invasive methods of treatment may improve the quality of life and increase the survival rate of this category of patients.

Keywords: Ascites; Diuretics; Large volume paracentesis; Liver cirrhosis; Peritoneovenous shunting; Transjugular intrahepatic portosystemic shunting.

Publication types

  • Review

MeSH terms

  • Adrenergic alpha-1 Receptor Agonists / therapeutic use
  • Ascites / diagnosis
  • Ascites / etiology
  • Ascites / mortality
  • Ascites / therapy*
  • Clinical Trials as Topic
  • Diuretics / therapeutic use
  • End Stage Liver Disease / diagnosis
  • End Stage Liver Disease / etiology
  • End Stage Liver Disease / mortality
  • End Stage Liver Disease / therapy*
  • Humans
  • Hypertension, Portal / diagnosis
  • Hypertension, Portal / etiology
  • Hypertension, Portal / mortality
  • Hypertension, Portal / therapy*
  • Liver Cirrhosis / complications
  • Liver Cirrhosis / diagnosis
  • Liver Cirrhosis / mortality
  • Liver Cirrhosis / therapy*
  • Liver Transplantation
  • Paracentesis / instrumentation
  • Paracentesis / methods
  • Portasystemic Shunt, Transjugular Intrahepatic
  • Prognosis
  • Quality of Life
  • Risk Assessment
  • Severity of Illness Index
  • Survival Rate
  • Treatment Outcome

Substances

  • Adrenergic alpha-1 Receptor Agonists
  • Diuretics