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Management of refractory cirrhotic ascites: challenges and solutions

Authors :
Fukui,Hiroshi
Kawaratani,Hideto
Kaji,Kosuke
Takaya,Hiroaki
Yoshiji,Hitoshi
Fukui,Hiroshi
Kawaratani,Hideto
Kaji,Kosuke
Takaya,Hiroaki
Yoshiji,Hitoshi
Publication Year :
2018

Abstract

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 sys

Details

Database :
OAIster
Notes :
text/html, English
Publication Type :
Electronic Resource
Accession number :
edsoai.on1051176826
Document Type :
Electronic Resource