Treatment of ascites: old and new remedies

Paolo Inturri, Agnese Graziotto, Lorenzo Rossaro

Research output: Contribution to journalArticle

10 Scopus citations

Abstract

Ascites is a common complication of chronic liver disease. Treatment of the underlying liver disease with modalities such as abstinence from alcohol in Laennec's cirrhosis, phlebotomy in hemochromatosis, copper removal in Wilson's disease, and steroids in autoimmune liver disease, can improve survival in many patients. In addition, therapy of ascites alleviates the symptoms and improves the quality of life of the patients, and probably decreases the incidence of life-threatening conditions including spontaneous bacterial peritonitis and hepatorenal syndrome. The mean survival rate at 2 years is approximately 50%. Precipitating factors such as gastrointestinal bleeding, nonsteroidal anti-inflammatory drugs and infections, should be identified, since most of them can be corrected. Most cirrhotics with ascites can be managed with a 'step-by-step' approach, including dietary salt restrictions, aldosterone antagonists, and loop diuretics. When tense or refractory ascites is present, largevolume paracentesis is safe and effective. Peritoneovenous shunting (i.e. Denver, LeVeen) is less frequently used because of perioperative morbidity and mortality, and thrombotic complications with occlusion of the stent. Reinfusion of concentrated ascites is of potential benefit and has been used in Europe. Transjugular intrahepatic portosystemic shunt (TIPS) is an alternative procedure performed by interventional radiologists that allows decompression of portal hypertension. In many cases, ascites is improved after TIPS, but long-term randomized trials for tense or refractory ascites comparing TIPS with standard therapy are not conclusive. Liver transplantation is the ultimate step for the treatment of ascites, providing the cure for the underlying liver disease as well. Transplantation is indicated when quality of life of the patient is impaired due to recurrent episodes of ascites, or in the presence of spontaneous bacterial peritonitis and hepatorenal syndrome.

Original languageEnglish (US)
Pages (from-to)145-156
Number of pages12
JournalDigestive Diseases
Volume14
Issue number3
StatePublished - May 1996
Externally publishedYes

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Keywords

  • Ascites
  • Diuretics
  • Liver transplantation
  • Paracentesis
  • Reinfusion of concentrated ascites
  • Transjugular intrahepatic portosystemic shunt

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Inturri, P., Graziotto, A., & Rossaro, L. (1996). Treatment of ascites: old and new remedies. Digestive Diseases, 14(3), 145-156.