Hepatic Ascites in Liver Cirrhosis

Abstract

Common complications of decompensated liver cirrhosis include esophageal varices, hepatic encephalopathy, and ascites. They are associated with a poor prognosis and quality of life. The 5-year mortality rate of patients with ascites is 44%. A decrease in ascites improves the quality of life and survival. A newer diuretic tolvaptan (a vasopressin V2 receptor antagonist) has been found to be effective in treating hepatic ascites, but there is as yet little evidence of its effect on prognosis. Other treatments for ascites include large-volume paracentesis, cell-free and concentrated ascites reinfusion therapy, and transjugular intrahepatic portosystemic or peritoneovenous shunts. Although these measure may improve quality of life, liver transplantation remains the only curative form of treatment. This paper discusses the therapeutic management of cirrhotic ascites according to Japanese guidelines.