Innovative approaches to the management of ascites in cirrhosis
Summary: Standard of care for the treatment of ascites in cirrhosis is to administer a sodium-restricted diet and diuretic therapy. The progression of cirrhosis will eventually lead to the development of refractory ascites, at which point diuretics will no longer be able to control the ascites. Seco...
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| Format: | Article |
| Language: | English |
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Elsevier
2023-07-01
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| Series: | JHEP Reports |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2589555923000800 |
| _version_ | 1827917750849241088 |
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| author | Florence Wong |
| author_facet | Florence Wong |
| author_sort | Florence Wong |
| collection | DOAJ |
| description | Summary: Standard of care for the treatment of ascites in cirrhosis is to administer a sodium-restricted diet and diuretic therapy. The progression of cirrhosis will eventually lead to the development of refractory ascites, at which point diuretics will no longer be able to control the ascites. Second-line therapies such as a transjugular intrahepatic portosystemic shunt (TIPS) placement or repeat large volume paracentesis are then required. There is some evidence that regular infusions of albumin may delay the onset of refractoriness and improve survival, especially if given at an early stage in the natural history of ascites and for a long enough duration. The use of TIPS can eliminate ascites, but its insertion is associated with complications, especially cardiac decompensation and worsening of hepatic encephalopathy. New information is now available regarding how to best select patients for TIPS, what type of cardiac investigations are needed and how under-dilating the TIPS at the time of insertion may help. The use of a non-absorbable antibiotics, such as rifaximin, starting in the pre-TIPS period may also reduce the likelihood of post-TIPS hepatic encephalopathy. In patients who are not suitable for TIPS, the use of an alfapump to remove the ascites via the bladder can improve quality of life without significantly altering survival. In the future it may be possible to use metabolomics to help refine the management of patients with ascites, e.g. to assess their response to non-selective beta-blockers or to predict the development of other complications such as acute kidney injury. |
| first_indexed | 2024-03-13T03:32:54Z |
| format | Article |
| id | doaj.art-e6a034fb8b294cff813925dcbafea104 |
| institution | Directory Open Access Journal |
| issn | 2589-5559 |
| language | English |
| last_indexed | 2024-03-13T03:32:54Z |
| publishDate | 2023-07-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JHEP Reports |
| spelling | doaj.art-e6a034fb8b294cff813925dcbafea1042023-06-24T05:18:28ZengElsevierJHEP Reports2589-55592023-07-0157100749Innovative approaches to the management of ascites in cirrhosisFlorence Wong0Department of Medicine, Division of Gastroenterology & Hepatology, University Health Network, University of Toronto, Toronto, Ontario, Canada; Corresponding author. Address: Room 222, 9th floor, Eaton Wing, Toronto General Hospital, 200 Elizabeth Street, Toronto, M5G2C4, Ontario, Canada. Tel.: 1-416-3403834; fax: 1-416-3405019.Summary: Standard of care for the treatment of ascites in cirrhosis is to administer a sodium-restricted diet and diuretic therapy. The progression of cirrhosis will eventually lead to the development of refractory ascites, at which point diuretics will no longer be able to control the ascites. Second-line therapies such as a transjugular intrahepatic portosystemic shunt (TIPS) placement or repeat large volume paracentesis are then required. There is some evidence that regular infusions of albumin may delay the onset of refractoriness and improve survival, especially if given at an early stage in the natural history of ascites and for a long enough duration. The use of TIPS can eliminate ascites, but its insertion is associated with complications, especially cardiac decompensation and worsening of hepatic encephalopathy. New information is now available regarding how to best select patients for TIPS, what type of cardiac investigations are needed and how under-dilating the TIPS at the time of insertion may help. The use of a non-absorbable antibiotics, such as rifaximin, starting in the pre-TIPS period may also reduce the likelihood of post-TIPS hepatic encephalopathy. In patients who are not suitable for TIPS, the use of an alfapump to remove the ascites via the bladder can improve quality of life without significantly altering survival. In the future it may be possible to use metabolomics to help refine the management of patients with ascites, e.g. to assess their response to non-selective beta-blockers or to predict the development of other complications such as acute kidney injury.http://www.sciencedirect.com/science/article/pii/S2589555923000800albuminalfapumpcontrolled expansion TIPSnon-selective beta blockerssodium glucose co-transporter 2 |
| spellingShingle | Florence Wong Innovative approaches to the management of ascites in cirrhosis JHEP Reports albumin alfapump controlled expansion TIPS non-selective beta blockers sodium glucose co-transporter 2 |
| title | Innovative approaches to the management of ascites in cirrhosis |
| title_full | Innovative approaches to the management of ascites in cirrhosis |
| title_fullStr | Innovative approaches to the management of ascites in cirrhosis |
| title_full_unstemmed | Innovative approaches to the management of ascites in cirrhosis |
| title_short | Innovative approaches to the management of ascites in cirrhosis |
| title_sort | innovative approaches to the management of ascites in cirrhosis |
| topic | albumin alfapump controlled expansion TIPS non-selective beta blockers sodium glucose co-transporter 2 |
| url | http://www.sciencedirect.com/science/article/pii/S2589555923000800 |
| work_keys_str_mv | AT florencewong innovativeapproachestothemanagementofascitesincirrhosis |