Evaluation and Management of Patients with Refractory Ascites

Overview

Journal World J Gastroenterol

Publisher Baishideng Publishing Group

Specialty Gastroenterology

Date 2008 Dec 31

PMID 19115470

Citations 17

Authors

Bahaa Eldeen Senousy

Peter V Draganov

Affiliations

Soon will be listed here.

Abstract

Some patients with ascites due to liver cirrhosis become no longer responsive to diuretics. Once other causes of ascites such as portal vein thrombosis, malignancy or infection and non-compliance with medications and low sodium diet have been excluded, the diagnosis of refractory ascites can be made based on strict criteria. Patients with refractory ascites have very poor prognosis and therefore referral for consideration for liver transplantation should be initiated. Search for reversible components of the underlying liver pathology should be undertaken and targeted therapy, when available, should be considered. Currently, serial large volume paracentesis (LVP) and transjugular intrahepatic portasystemic stent-shunt (TIPS) are the two mainstay treatment options for refractory ascites. Other treatment options are available but not widely used either because they carry high morbidity and mortality (most surgical options) rates, or are new interventions that have shown promise but still need further evaluation. In this comprehensive review, we describe the evaluation and management of patients with refractory ascites from the prospective of the practicing physician.

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References

Lata J, Marecek Z, Fejfar T, Zdenek P, Bruha R, Safka V . The efficacy of terlipressin in comparison with albumin in the prevention of circulatory changes after the paracentesis of tense ascites--a randomized multicentric study. Hepatogastroenterology. 2008; 54(79):1930-3. View

Gines P, Berl T, Bernardi M, Bichet D, Hamon G, Jimenez W . Hyponatremia in cirrhosis: from pathogenesis to treatment. Hepatology. 1998; 28(3):851-64. DOI: 10.1002/hep.510280337. View

Runyon B . Care of patients with ascites. N Engl J Med. 1994; 330(5):337-42. DOI: 10.1056/NEJM199402033300508. View

Biggins S, Rodriguez H, Bacchetti P, Bass N, Roberts J, Terrault N . Serum sodium predicts mortality in patients listed for liver transplantation. Hepatology. 2005; 41(1):32-9. DOI: 10.1002/hep.20517. View

Boyer T . Transjugular intrahepatic portosystemic shunt: current status. Gastroenterology. 2003; 124(6):1700-10. DOI: 10.1016/s0016-5085(03)00377-9. View

Singh V, Dheerendra P, Singh B, Nain C, Chawla D, Sharma N . Midodrine versus albumin in the prevention of paracentesis-induced circulatory dysfunction in cirrhotics: a randomized pilot study. Am J Gastroenterol. 2008; 103(6):1399-405. DOI: 10.1111/j.1572-0241.2008.01787.x. View

Romanelli R, La Villa G, Barletta G, Vizzutti F, Lanini F, Arena U . Long-term albumin infusion improves survival in patients with cirrhosis and ascites: an unblinded randomized trial. World J Gastroenterol. 2006; 12(9):1403-7. PMC: 4124318. DOI: 10.3748/wjg.v12.i9.1403. View

Malekzadeh R, Mohamadnejad M, Nasseri-Moghaddam S, Rakhshani N, Tavangar S, Sohrabpour A . Reversibility of cirrhosis in autoimmune hepatitis. Am J Med. 2004; 117(2):125-9. DOI: 10.1016/j.amjmed.2004.01.026. View

McVay P, Toy P . Lack of increased bleeding after paracentesis and thoracentesis in patients with mild coagulation abnormalities. Transfusion. 1991; 31(2):164-71. DOI: 10.1046/j.1537-2995.1991.31291142949.x. View

10.

Rai R, Jain P . Combination of clonidine and diuretic in cirrhotic ascites with activated sympathetic nervous system: Would it be a magical bullet?. Hepatology. 2007; 47(1):360. DOI: 10.1002/hep.21771. View

11.

Bories P, Garcia Compean D, Michel H, BOUREL M, Capron J, Gauthier A . The treatment of refractory ascites by the LeVeen shunt. A multi-centre controlled trial (57 patients). J Hepatol. 1986; 3(2):212-8. DOI: 10.1016/s0168-8278(86)80028-9. View

12.

Pamuk O, Sonsuz A . The effect of mannitol infusion on the response to diuretic therapy in cirrhotic patients with ascites. J Clin Gastroenterol. 2002; 35(5):403-5. DOI: 10.1097/00004836-200211000-00009. View

13.

Papadakis M, Arieff A . Unpredictability of clinical evaluation of renal function in cirrhosis. Prospective study. Am J Med. 1987; 82(5):945-52. DOI: 10.1016/0002-9343(87)90156-2. View

14.

Moore K, Aithal G . Guidelines on the management of ascites in cirrhosis. Gut. 2006; 55 Suppl 6:vi1-12. PMC: 1860002. DOI: 10.1136/gut.2006.099580. View

15.

Bernardi M, Laffi G, Salvagnini M, Azzena G, Bonato S, Marra F . Efficacy and safety of the stepped care medical treatment of ascites in liver cirrhosis: a randomized controlled clinical trial comparing two diets with different sodium content. Liver. 1993; 13(3):156-62. DOI: 10.1111/j.1600-0676.1993.tb00624.x. View

16.

Gines P, Guevara M, de Las Heras D, Arroyo V . Review article: albumin for circulatory support in patients with cirrhosis. Aliment Pharmacol Ther. 2002; 16 Suppl 5:24-31. DOI: 10.1046/j.1365-2036.16.s5.4.x. View

17.

Chang C, Singal A, Ganeshan S, Schiano T, Lookstein R, Emre S . Use of splenic artery embolization to relieve tense ascites following liver transplantation in a patient with paroxysmal nocturnal hemoglobinuria. Liver Transpl. 2007; 13(11):1532-7. DOI: 10.1002/lt.21317. View

18.

Gines P, Arroyo V, Quintero E, Planas R, Bory F, Cabrera J . Comparison of paracentesis and diuretics in the treatment of cirrhotics with tense ascites. Results of a randomized study. Gastroenterology. 1987; 93(2):234-41. DOI: 10.1016/0016-5085(87)91007-9. View

19.

Wilkinson P, Sherlock S . The effect of repeated albumin infusions in patients with cirrhosis. Lancet. 1962; 2(7266):1125-9. DOI: 10.1016/s0140-6736(62)90895-4. View

20.

Bureau C, Garcia-Pagan J, Otal P, Pomier-Layrargues G, Chabbert V, Cortez C . Improved clinical outcome using polytetrafluoroethylene-coated stents for TIPS: results of a randomized study. Gastroenterology. 2004; 126(2):469-75. DOI: 10.1053/j.gastro.2003.11.016. View