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Practice Guideline
. 2021 Jan;70(1):9-29.
doi: 10.1136/gutjnl-2020-321790. Epub 2020 Oct 16.

Guidelines on the management of ascites in cirrhosis

Guruprasad P Aithal  1   2 , Naaventhan Palaniyappan  3   2 , Louise China  4 , Suvi Härmälä  5 , Lucia Macken  6   7 , Jennifer M Ryan  4   8 , Emilie A Wilkes  2   9 , Kevin Moore  4 , Joanna A Leithead  10 , Peter C Hayes  11 , Alastair J O'Brien  4 , Sumita Verma  6   7
Affiliations
Practice Guideline

Guidelines on the management of ascites in cirrhosis

Guruprasad P Aithal et al. Gut. 2021 Jan.

Abstract

The British Society of Gastroenterology in collaboration with British Association for the Study of the Liver has prepared this document. The aim of this guideline is to review and summarise the evidence that guides clinical diagnosis and management of ascites in patients with cirrhosis. Substantial advances have been made in this area since the publication of the last guideline in 2007. These guidelines are based on a comprehensive literature search and comprise systematic reviews in the key areas, including the diagnostic tests, diuretic use, therapeutic paracentesis, use of albumin, transjugular intrahepatic portosystemic stent shunt, spontaneous bacterial peritonitis and beta-blockers in patients with ascites. Where recent systematic reviews and meta-analysis are available, these have been updated with additional studies. In addition, the results of prospective and retrospective studies, evidence obtained from expert committee reports and, in some instances, reports from case series have been included. Where possible, judgement has been made on the quality of information used to generate the guidelines and the specific recommendations have been made according to the 'Grading of Recommendations Assessment, Development and Evaluation (GRADE)' system. These guidelines are intended to inform practising clinicians, and it is expected that these guidelines will be revised in 3 years' time.

Keywords: ascites; cirrhosis.

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Conflict of interest statement

Competing interests: SV and LM: Received support from Rocket Medical for the NIHR funded REDUce Study.

Figures

Figure 1
Figure 1
The pathogenesis of ascites in cirrhosis.
Figure 2
Figure 2
The ascitic fluid samples required from diagnostic paracentesis. *These investigations should be considered based on pretest probability of specific diagnosis. BNP, brain natriuretic peptide.
Figure 3
Figure 3
Approach to the use of diuretics in the management of ascites in patients with cirrhosis.
Figure 4
Figure 4
Anatomical landmarks for the safe performance of paracentesis [A] and performance of ascites drainage in patients with large ascites [B].
See this image and copyright information in PMC

Comment in

References

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