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Review
. 2024 Mar;12(2):261-272.
doi: 10.1002/ueg2.12539. Epub 2024 Feb 10.

Recent developments in the management of ascites in cirrhosis

Tian Lan  1   2 , Ming Chen  1   2 , Chengwei Tang  1   2 , Pierre Deltenre  3   4   5
Affiliations
Review

Recent developments in the management of ascites in cirrhosis

Tian Lan et al. United European Gastroenterol J. 2024 Mar.

Abstract

In recent years, advances have been made for treating ascites in patients with cirrhosis. Recent studies have indicated that several treatments that have been used for a long time in the management of portal hypertension may have beneficial effects that were not previously identified. Long-term albumin infusion may improve survival in patients with cirrhosis and ascites while beta-blockers may reduce ascites occurrence. Transjugular intrahepatic porto-systemic shunt (TIPS) placement may also improve survival in selected patients in addition to the control with ascites. Low-flow ascites pump insertion can be another option for some patients with intractable ascites. In this review, we summarize the latest data related to the management of ascites occurring in cirrhosis. There are still unanswered questions, such as the optimal use of albumin as a long-term therapy, the place of beta-blockers, and the best timing for TIPS placement to improve the natural history of ascites, as well as the optimal stent diameter to reduce the risk of shunt-related side-effects. These issued should be addressed in future studies.

Keywords: albumin; ascites; ascites pump; liver cirrhosis; transjugular intrahepatic porto‐systemic shunt.

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Conflict of interest statement

The authors have no conflicts of interest to declare.

Figures

FIGURE 1
FIGURE 1
The pathogenesis and therapeutic targets of ascites in cirrhosis. The pathophysiological mechanisms of ascites formation involve impaired liver function, portal hypertension, vascular dysfunction, and systemic inflammation. Therapeutic options include etiological treatment, sodium control, diuretics, beta‐blockers, albumin infusion, paracentesis, transjugular intrahepatic portosystemic shunt (TIPS), Alphapump, and liver transplantation. Therapeutic interventions that are capable of modifying the course of the disease are indicated in green and those that are not are indicated in orange.
FIGURE 2
FIGURE 2
Indications of TIPS in ascites. PHT, portal hypertension; TIPS, transjugular intrahepatic porto‐systemic shunt. Adapted from ref.
See this image and copyright information in PMC

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