Refractory ascites in cirrhosis: Mechanism and treatment

V. Arroyo, M. Epstein, G. Gallus, P. Gentilini, H. Ring-Larsen, F. Salerno

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Refractory ascites (or diuretic-resistant ascites), i.e. the ascites that cannot be mobilised by medical treatment (low sodium diet and high doses of furosemide and spironolactone), is an infrequent phenomenon in cirrhosis. It usually occurs in patients with functional renal failure as a consequence of alterations in both pharmacokinetics and pharmacodynamics of diuretics. Peritoneo-venous shunting, a procedure which improves systemic haemodynamics and renal function in cirrhotics with ascites, has been proposed as the treatment of choice in patients with refractory ascites. Unfortunately, it is associated with a high rate of severe complications and does not prolong the survival of these patients. Recent studies have shown that large-volume paracentesis plus i.v. albumin infusion is an effective and safe therapy of ascites in cirrhosis and that it could be an alternative treatment for refractoy ascites. Controlled trials are needed to determine which of these two therapeutic procedures is better for the management of diuretic-resistant ascites in cirrhosis.

Original languageEnglish
Pages (from-to)195-207
Number of pages13
JournalGastroenterology International
Issue number4
Publication statusPublished - 1989

ASJC Scopus subject areas

  • Gastroenterology


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