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World J Gastroenterol. Jul 28, 2019; 25(28): 3738-3752
Published online Jul 28, 2019. doi: 10.3748/wjg.v25.i28.3738
Current approaches to the management of patients with cirrhotic ascites
Dmitry Victorovich Garbuzenko, Nikolay Olegovich Arefyev
Dmitry Victorovich Garbuzenko, Department of Faculty Surgery, South Ural State Medical University, Chelyabinsk 454092, Russia
Nikolay Olegovich Arefyev, Department of Pathological Anatomy and Forensic Medicine, South Ural State Medical University, Chelyabinsk 454092, Russia
Author contributions: Garbuzenko DV contributed to the conception, design, acquisition, analysis, interpretation of data, wrote the manuscript and approved the final version; Arefyev NO contributed to analysis of data, wrote and revised the manuscript, generated the figures, and approved the final version.
Conflict-of-interest statement: The authors have nothing to disclose.
Open-Access: This is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Dmitry Victorovich Garbuzenko, MD, PhD, Professor, Department of Faculty Surgery, South Ural State Medical University, PO Box 12317, Chelyabinsk 454080, Russia. garb@inbox.ru
Telephone: +7-909-7459826 Fax: +7-351-2687772
Received: April 16, 2019
Peer-review started: April 16, 2019
First decision: April 30, 2019
Revised: May 9, 2019
Accepted: June 25, 2019
Article in press: June 26, 2019
Published online: July 28, 2019
Processing time: 103 Days and 16.1 Hours
Abstract

This review describes current approaches to the management of patients with cirrhotic ascites in relation to the severity of its clinical manifestations. The PubMed database, the Google Scholar retrieval system, the Cochrane Database of Systematic Reviews, and the reference lists from related articles were used to search for relevant publications. Articles corresponding to the aim of the review were selected for 1991-2018 using the keywords: “liver cirrhosis,” “portal hypertension,” “ascites,” “pathogenesis,” “diagnostics,” and “treatment.” Uncomplicated and refractory ascites in patients with cirrhosis were the inclusion criteria. The literature analysis has shown that despite the achievements of modern hepatology, the presence of ascites is associated with poor prognosis and high mortality. The key to successful management of patients with ascites may be the stratification of the risk of an adverse outcome and personalized therapy. Pathogenetically based approach to the choice of pharmacotherapy and optimization of minimally invasive methods of treatment may improve the quality of life and increase the survival rate of this category of patients.

Keywords: Liver cirrhosis; Ascites; Diuretics; Large volume paracentesis; Peritoneovenous shunting; Transjugular intrahepatic portosystemic shunting

Core tip: This review describes current approaches to the management of patients with cirrhotic ascites in relation to the severity of its clinical manifestations. The literature analysis has shown that despite the achievements of modern hepatology, the presence of ascites is associated with poor prognosis and high mortality. The key to successful management of patients with ascites may be the stratification of the risk of an adverse outcome and personalized therapy. Pathogenetically based approach to the choice of pharmacotherapy and optimization of minimally invasive methods of treatment may improve the quality of life and increase the survival rate of this category of patients.