Published online Oct 8, 2016. doi: 10.4254/wjh.v8.i28.1182
Peer-review started: March 14, 2016
First decision: April 20, 2016
Revised: July 22, 2016
Accepted: August 6, 2016
Article in press: August 8, 2016
Published online: October 8, 2016
Cirrhosis is a major cause of morbidity and mortality worldwide with liver transplantations as it only possible cure. In the face of a significant organ shortage many patients die waiting. A major complication of cirrhosis is the development of portal hypertension and ascites. The management of ascites has barely evolved over the last hundred years and includes only a few milestones in our treatment approach, but has overall significantly improved patient morbidity and survival. Our mainstay to ascites management includes changes in diet, diuretics, shunt procedures, and large volume paracentesis. The understanding of the pathophysiology of cirrhosis and portal hypertension has significantly improved in the last couple of decades but the changes in ascites management have not seemed to mirror this newer knowledge. We herein review the history of ascites management and discuss some its current limitations.
Core tip: Few randomized control studies have been performed in the management of refractory ascites, of which all were performed either in the pre-model for end-stage liver disease (MELD) era or done in patients with low MELD scores. As such, most of the management guidelines have significant limitations in its utility for patients admitted to the hospital with significant hemodynamic dysfunction and other complications of cirrhosis. Our objective is to review the origins of our current management of refractory ascites and its limitations.