$Management of refractory cirrhotic ascites: challenges and solutions$
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Management of refractory cirrhotic ascites: challenges and solutions

Hiroshi Fukui, Hideto Kawaratani, Kosuke Kaji, Hiroaki Takaya, Hitoshi Yoshiji Department of Gastroenterology, Endocrinology and Metabolism, Nara Medical University, Nara, Japan Abstract: Among the various risky complications of liver cirrhosis, refractory ascites is associated with poor survival of...

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Autores principales:	Fukui H, Kawaratani H, Kaji K, Takaya H, Yoshiji H
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2018
Materias:	refractory ascites liver cirrhosis pathophysiology pharmacotherapy interventional therapy Diseases of the digestive system. Gastroenterology RC799-869
Acceso en línea:	https://doaj.org/article/ceae9cc36520405faf08e0e3b94d011a
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spelling	oai:doaj.org-article:ceae9cc36520405faf08e0e3b94d011a2021-12-02T02:24:22ZManagement of refractory cirrhotic ascites: challenges and solutions1179-1535https://doaj.org/article/ceae9cc36520405faf08e0e3b94d011a2018-07-01T00:00:00Zhttps://www.dovepress.com/management-of-refractory-cirrhotic-ascites-challenges-and-solutions-peer-reviewed-article-HMERhttps://doaj.org/toc/1179-1535Hiroshi Fukui, Hideto Kawaratani, Kosuke Kaji, Hiroaki Takaya, Hitoshi Yoshiji Department of Gastroenterology, Endocrinology and Metabolism, Nara Medical University, Nara, Japan Abstract: Among the various risky complications of liver cirrhosis, refractory ascites is associated with poor survival of cirrhotics and persistently worsens their quality of life (QOL). Major clinical guidelines worldwide define refractory ascites as ascites that cannot be managed by medical therapy either because of a lack of response to maximum doses of diuretics or because patients develop complications related to diuretic therapy that preclude the use of an effective dose of diuretics. Due to the difficulty in receiving a liver transplantation (LT), the ultimate solution for refractory ascites, most cirrhotic patients have selected the palliative therapy such as repeated serial paracentesis, transjugular intrahepatic portosystemic shunt, or peritoneovenous shunt to improve their QOL. During the past several decades, new interventions and methodologies, such as indwelling peritoneal catheter, peritoneal-urinary drainage, and cell-free and concentrated ascites reinfusion therapy, have been introduced. In addition, new medical treatments with vasoconstrictors or vasopressin V2 receptor antagonists have been proposed. Both the benefits and risks of these old and new modalities have been extensively studied in relation to the pathophysiological changes in ascites formation. Although the best solution for refractory ascites is to eliminate hepatic failure either by LT or by causal treatment, the selection of the best palliative therapy for individual patients is of utmost importance, aiming at achieving the longest possible, comfortable life. This review briefly summarizes the changing landscape of variable treatment modalities for cirrhotic patients with refractory ascites, aiming at clarifying their possibilities and limitations. Evolving issues with regard to the impact of gut-derived systemic and local infection on the clinical course of cirrhotic patients have paved the way for the development of a new gut microbiome-based therapeutics. Thus, it should be further investigated whether the early therapeutic approach to gut dysbiosis provides a better solution for the management of cirrhotic ascites. Keywords: pathophysiology, nonselective beta-blockers, V2 receptor antagonists, large-volume paracentesis, peritoneovenous shunt, transjugular intrahepatic portosystemic shunt, antibioticsFukui HKawaratani HKaji KTakaya HYoshiji HDove Medical Pressarticlerefractory ascitesliver cirrhosispathophysiologypharmacotherapyinterventional therapyDiseases of the digestive system. GastroenterologyRC799-869ENHepatic Medicine: Evidence and Research, Vol Volume 10, Pp 55-71 (2018)
institution	DOAJ
collection	DOAJ
language	EN
topic	refractory ascites liver cirrhosis pathophysiology pharmacotherapy interventional therapy Diseases of the digestive system. Gastroenterology RC799-869
spellingShingle	refractory ascites liver cirrhosis pathophysiology pharmacotherapy interventional therapy Diseases of the digestive system. Gastroenterology RC799-869 Fukui H Kawaratani H Kaji K Takaya H Yoshiji H Management of refractory cirrhotic ascites: challenges and solutions
description	Hiroshi Fukui, Hideto Kawaratani, Kosuke Kaji, Hiroaki Takaya, Hitoshi Yoshiji Department of Gastroenterology, Endocrinology and Metabolism, Nara Medical University, Nara, Japan Abstract: Among the various risky complications of liver cirrhosis, refractory ascites is associated with poor survival of cirrhotics and persistently worsens their quality of life (QOL). Major clinical guidelines worldwide define refractory ascites as ascites that cannot be managed by medical therapy either because of a lack of response to maximum doses of diuretics or because patients develop complications related to diuretic therapy that preclude the use of an effective dose of diuretics. Due to the difficulty in receiving a liver transplantation (LT), the ultimate solution for refractory ascites, most cirrhotic patients have selected the palliative therapy such as repeated serial paracentesis, transjugular intrahepatic portosystemic shunt, or peritoneovenous shunt to improve their QOL. During the past several decades, new interventions and methodologies, such as indwelling peritoneal catheter, peritoneal-urinary drainage, and cell-free and concentrated ascites reinfusion therapy, have been introduced. In addition, new medical treatments with vasoconstrictors or vasopressin V2 receptor antagonists have been proposed. Both the benefits and risks of these old and new modalities have been extensively studied in relation to the pathophysiological changes in ascites formation. Although the best solution for refractory ascites is to eliminate hepatic failure either by LT or by causal treatment, the selection of the best palliative therapy for individual patients is of utmost importance, aiming at achieving the longest possible, comfortable life. This review briefly summarizes the changing landscape of variable treatment modalities for cirrhotic patients with refractory ascites, aiming at clarifying their possibilities and limitations. Evolving issues with regard to the impact of gut-derived systemic and local infection on the clinical course of cirrhotic patients have paved the way for the development of a new gut microbiome-based therapeutics. Thus, it should be further investigated whether the early therapeutic approach to gut dysbiosis provides a better solution for the management of cirrhotic ascites. Keywords: pathophysiology, nonselective beta-blockers, V2 receptor antagonists, large-volume paracentesis, peritoneovenous shunt, transjugular intrahepatic portosystemic shunt, antibiotics
format	article
author	Fukui H Kawaratani H Kaji K Takaya H Yoshiji H
author_facet	Fukui H Kawaratani H Kaji K Takaya H Yoshiji H
author_sort	Fukui H
title	Management of refractory cirrhotic ascites: challenges and solutions
title_short	Management of refractory cirrhotic ascites: challenges and solutions
title_full	Management of refractory cirrhotic ascites: challenges and solutions
title_fullStr	Management of refractory cirrhotic ascites: challenges and solutions
title_full_unstemmed	Management of refractory cirrhotic ascites: challenges and solutions
title_sort	management of refractory cirrhotic ascites: challenges and solutions
publisher	Dove Medical Press
publishDate	2018
url	https://doaj.org/article/ceae9cc36520405faf08e0e3b94d011a
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Management of refractory cirrhotic ascites: challenges and solutions

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