Management of Ascites in Patients with Cirrhosis: An Update

Ascites represents a critical event in the natural history of liver cirrhosis. From a prognostic perspective, its occurrence marks the transition from the compensated to the decompensated stage of the disease, leading to an abrupt worsening of patients’ life expectancy. Moreover, ascites heralds a t...

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Autores principales:	Giacomo Zaccherini, Manuel Tufoni, Giulia Iannone, Paolo Caraceni
Formato:	article
Lenguaje:	EN
Publicado:	MDPI AG 2021
Materias:	decompensated cirrhosis portal hypertension effective hypovolemia anti-mineralocorticoids loop diuretics vaptans Medicine R
Acceso en línea:	https://doaj.org/article/2bbd4a628cbf42b7bda2980ac1629461
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spelling	oai:doaj.org-article:2bbd4a628cbf42b7bda2980ac16294612021-11-25T18:00:39ZManagement of Ascites in Patients with Cirrhosis: An Update10.3390/jcm102252262077-0383https://doaj.org/article/2bbd4a628cbf42b7bda2980ac16294612021-11-01T00:00:00Zhttps://www.mdpi.com/2077-0383/10/22/5226https://doaj.org/toc/2077-0383Ascites represents a critical event in the natural history of liver cirrhosis. From a prognostic perspective, its occurrence marks the transition from the compensated to the decompensated stage of the disease, leading to an abrupt worsening of patients’ life expectancy. Moreover, ascites heralds a turbulent clinical course, characterized by acute events and further complications, frequent hospitalizations, and eventually death. The pathophysiology of ascites classically relies on hemodynamic mechanisms, with effective hypovolemia as the pivotal event. Recent discoveries, however, integrated this hypothesis, proposing systemic inflammation and immune system dysregulation as key mechanisms. The mainstays of ascites treatment are represented by anti-mineralocorticoids and loop diuretics, and large volume paracentesis. When ascites reaches the stage of refractoriness, however, diuretics administration should be cautious due to the high risk of adverse events, and patients should be treated with periodic execution of paracentesis or with the placement of a trans-jugular intra-hepatic portosystemic shunt (TIPS). TIPS reduces portal hypertension, eases ascites control, and potentially modify the clinical course of the disease. Further studies are required to expand its indications and improve the management of complications. Long-term human albumin administration has been studied in two RCTs, with contradictory results, and remains a debated issue worldwide, despite a potential effectiveness both in ascites control and long-term survival. Other treatments (vaptans, vasoconstrictors, or implantable drainage systems) present some promising aspects but cannot be currently recommended outside clinical protocols or a case-by-case evaluation.Giacomo ZaccheriniManuel TufoniGiulia IannonePaolo CaraceniMDPI AGarticledecompensated cirrhosisportal hypertensioneffective hypovolemiaanti-mineralocorticoidsloop diureticsvaptansMedicineRENJournal of Clinical Medicine, Vol 10, Iss 5226, p 5226 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	decompensated cirrhosis portal hypertension effective hypovolemia anti-mineralocorticoids loop diuretics vaptans Medicine R
spellingShingle	decompensated cirrhosis portal hypertension effective hypovolemia anti-mineralocorticoids loop diuretics vaptans Medicine R Giacomo Zaccherini Manuel Tufoni Giulia Iannone Paolo Caraceni Management of Ascites in Patients with Cirrhosis: An Update
description	Ascites represents a critical event in the natural history of liver cirrhosis. From a prognostic perspective, its occurrence marks the transition from the compensated to the decompensated stage of the disease, leading to an abrupt worsening of patients’ life expectancy. Moreover, ascites heralds a turbulent clinical course, characterized by acute events and further complications, frequent hospitalizations, and eventually death. The pathophysiology of ascites classically relies on hemodynamic mechanisms, with effective hypovolemia as the pivotal event. Recent discoveries, however, integrated this hypothesis, proposing systemic inflammation and immune system dysregulation as key mechanisms. The mainstays of ascites treatment are represented by anti-mineralocorticoids and loop diuretics, and large volume paracentesis. When ascites reaches the stage of refractoriness, however, diuretics administration should be cautious due to the high risk of adverse events, and patients should be treated with periodic execution of paracentesis or with the placement of a trans-jugular intra-hepatic portosystemic shunt (TIPS). TIPS reduces portal hypertension, eases ascites control, and potentially modify the clinical course of the disease. Further studies are required to expand its indications and improve the management of complications. Long-term human albumin administration has been studied in two RCTs, with contradictory results, and remains a debated issue worldwide, despite a potential effectiveness both in ascites control and long-term survival. Other treatments (vaptans, vasoconstrictors, or implantable drainage systems) present some promising aspects but cannot be currently recommended outside clinical protocols or a case-by-case evaluation.
format	article
author	Giacomo Zaccherini Manuel Tufoni Giulia Iannone Paolo Caraceni
author_facet	Giacomo Zaccherini Manuel Tufoni Giulia Iannone Paolo Caraceni
author_sort	Giacomo Zaccherini
title	Management of Ascites in Patients with Cirrhosis: An Update
title_short	Management of Ascites in Patients with Cirrhosis: An Update
title_full	Management of Ascites in Patients with Cirrhosis: An Update
title_fullStr	Management of Ascites in Patients with Cirrhosis: An Update
title_full_unstemmed	Management of Ascites in Patients with Cirrhosis: An Update
title_sort	management of ascites in patients with cirrhosis: an update
publisher	MDPI AG
publishDate	2021
url	https://doaj.org/article/2bbd4a628cbf42b7bda2980ac1629461
work_keys_str_mv	AT giacomozaccherini managementofascitesinpatientswithcirrhosisanupdate AT manueltufoni managementofascitesinpatientswithcirrhosisanupdate AT giuliaiannone managementofascitesinpatientswithcirrhosisanupdate AT paolocaraceni managementofascitesinpatientswithcirrhosisanupdate
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Management of Ascites in Patients with Cirrhosis: An Update

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