| Theme |
Diagnosis and Treatment of Portal Hypertention |
| Title |
Diagnosis and Treatment of Ascites and Refractory Ascites |
| Author |
Hidenori Kanazawa |
Department of Gastroenterology, Nippon Medical School |
| Author |
Yoshiyuki Narahara |
Department of Gastroenterology, Nippon Medical School |
| Author |
Yasuhisa Nakatuka |
Department of Gastroenterology, Nippon Medical School |
| Author |
Chyoitsu Sakamoto |
Department of Gastroenterology, Nippon Medical School |
| [ Summary ] |
Cirrhotic ascites results from portal hypertension and sodium and water retention, which is secondary to a decreased effective arterial blood volume. Approximately 50 % of patients with compensated cirrhosis will develop ascites over a 10-year period. This occurrence is an important milestone in the natural history of end-stage liver disease because only 45 % of patients survive 5 years after onset. Salt restriction and diuretics are the mainstays of therapy, and these measures are effective in approximately 90 % of patients. Refractory ascites in which ascites cannot be mobilized despite sodium restriction and maximum dose of diuretic treatment occurs in 5 - 1O % of patients with ascites. There is a one-year survival rate of less than 50 % for these patients. Large volume paracentesis with albumin and transjugular intrahepatic portosystemic shunt are useful in managing patients with refractory ascites. Liver transplantation is the only way to improve survival in patients with refractory ascites caused by cirrhosis. |