An update on the pathogenesis and clinical management of cirrhosis with refractory ascites

Expert Review of Gastroenterology & Hepatology
Shuet Fong NeongFlorence Wong

Abstract

Ascites commonly complicates cirrhosis, becoming refractory to treatment with diuretics and sodium restriction in approximately 10% of patients. Pathogenesis of refractory ascites (RA) is multifactorial, the common final pathway being renal hypoperfusion and avid sodium retention. Refractory ascites has a negative prognostic implication in the natural history of cirrhosis. Management of RA include sodium restriction and regular large volume paracentesis (LVP) with albumin infusions, preventing paracentesis-induced circulatory dysfunction. In appropriate setting, transjugular intrahepatic porto-systemic shunt (TIPS) can be considered. Ascites clearance with TIPS can lead to nutritional improvement, avoiding sarcopenia. Liver transplantation (LT) remains the definitive treatment for eligible candidates. Areas covered: Our review summarizes current updates on pathogenesis and clinical management of RA including potential future therapeutic options such as the automated slow-flow ascites pump, chronic outpatient albumin infusion and cell-free and concentrated ascites reinfusion therapy. Expert commentary: Standard of care in patients with RA include LVP with albumin replacement and prompt referral for LT where indicated. Other nove...Continue Reading

References

Feb 24, 2001·Journal of Hepatology·G Fernández-EsparrachJ Rodés
Mar 10, 2001·Canadian Journal of Gastroenterology = Journal Canadien De Gastroenterologie·S MøllerJ H Henriksen
Aug 30, 2002·Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society·Richard B FreemanUNKNOWN UNOS/OPTN Liver Disease Severity Score, UNOS/OPTN Liver and Intestine, and UNOS/OPTN Pediatric Transplantation Committees
Oct 3, 2002·The American Journal of Gastroenterology·Tilman M BauerHubert E Blum
Apr 30, 2003·Hepatology : Official Journal of the American Association for the Study of Liver Diseases·Javier Sola-VeraCarlos Guarner
Jun 27, 2003·Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society·Attaphol PawarodePaul J Thuluvath
Jun 28, 2003·Hepatology : Official Journal of the American Association for the Study of Liver Diseases·Kevin P MooreVicente Arroyo
Sep 5, 2003·The New England Journal of Medicine·Akinlolu O OjoRobert M Merion
Apr 16, 2004·The New England Journal of Medicine·Pere GinèsJuan Rodés
Sep 1, 2004·Digestive and Liver Disease : Official Journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver·P GentiliniR G Romanelli
Sep 16, 2004·Hepatology : Official Journal of the American Association for the Study of Liver Diseases·Catherine M GrabauPatrick S Kamath
Oct 16, 2004·Liver International : Official Journal of the International Association for the Study of the Liver·José A Girón-GonzálezLeopoldo Martín-Herrera
Feb 4, 2005·Hepatology : Official Journal of the American Association for the Study of Liver Diseases·Scott W BigginsNorah A Terrault
Apr 19, 2005·Hepatology : Official Journal of the American Association for the Study of Liver Diseases·Carlo AlessandriaPere Ginès
Sep 28, 2005·Digestive and Liver Disease : Official Journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver·C-H LinP C-I Ko
Jan 20, 2006·Liver International : Official Journal of the International Association for the Study of the Liver·Richard MoreauZéra Tellier
Mar 23, 2006·World Journal of Gastroenterology : WJG·Roberto-Giulio RomanelliGiacomo Laffi
Apr 6, 2007·Gastroenterology·Swee H TehPatrick S Kamath
Jun 15, 2007·Journal of the American Society of Nephrology : JASN·Robert W Schrier
Aug 9, 2008·Digestive Diseases and Sciences·Ashish KumarShiv Kumar Sarin
Sep 30, 2008·Liver International : Official Journal of the International Association for the Study of the Liver·Carmen Landaverde, Sammy Saab
Nov 13, 2008·Hepatology : Official Journal of the American Association for the Study of Liver Diseases·Pedro ZapaterJosé Such
Dec 31, 2008·World Journal of Gastroenterology : WJG·Bahaa Eldeen Senousy, Peter V Draganov
May 29, 2009·Hepatology Research : the Official Journal of the Japan Society of Hepatology·Khalid A TaziRichard Moreau
Aug 12, 2009·Hepatology International·Søren MøllerFlemming Bendtsen
May 25, 2010·Liver International : Official Journal of the International Association for the Study of the Liver·Francesco SalernoSamuel S Lee
Jul 17, 2010·Journal of Hepatology·UNKNOWN European Association for the Study of the Liver
Dec 31, 2010·American Journal of Therapeutics·Shashideep SinghalSury Anand
Feb 1, 2011·Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society·Ma SomsoukScott W Biggins
Feb 18, 2011·Current Opinion in Critical Care·Hongqun Liu, Samuel S Lee
Sep 16, 2011·Journal of Gastroenterology and Hepatology·Florence Wong
Oct 19, 2011·Annals of Internal Medicine·Michael L VolkRenee R Anspach
Nov 19, 2011·Hepatology : Official Journal of the American Association for the Study of Liver Diseases·Mauro BernardiMahlon M Wilkes
May 1, 2012·Clinics in Liver Disease·Fredric D Gordon
Sep 27, 2012·European Journal of Gastroenterology & Hepatology·Cynthia TsienSrinivasan Dasarathy
Jan 1, 2014·Journal of Hepatology·Jasmohan S BajajPatrick M Gillevet

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Citations

Nov 19, 2019·Clinical and Molecular Hepatology·Nicoletta De MatthaeisLuca Miele
Apr 9, 2020·Cells·Natascha RoehlenThomas F Baumert
Mar 31, 2021·Abdominal Radiology·William P PerryRajan T Gupta
Dec 22, 2020·Surgical Laparoscopy, Endoscopy & Percutaneous Techniques·Chenchen GuoJunsheng Li
Aug 19, 2021·Revista da Associação Médica Brasileira·Marcela Rodrigues de SiqueiraCarla Malaguti
Jun 20, 2021·Clinics and Research in Hepatology and Gastroenterology·Matthieu HalfonSebastien Kissling

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