Road map of the diagnosis and treatment of intractable ascites based on guidelines for the diagnosis and treatment of cirrhotic ascites and related complications / 临床肝胆病杂志

ABSTRACT

Guidelines for the diagnosis and treatment of cirrhotic ascites and related complications put forward the new criteria for the diagnosis and treatment of intractable cirrhotic ascites, and spontaneous bacterial peritonitis is a common cause of intractable cirrhotic ascites. About 50％ -89％ of patients with intractable cirrhotic ascites have a significant response to terlipressin (2-8 mg/d), midodrine hydrochloride (22. 5 mg/d), and tolvaptan (7. 5-15 mg/d) . Intravenous albumin supplementation (8 g/1000 ml ascites) has a similar therapeutic effect as terlipressin (3 mg) in preventing posterior circulation dysfunction after large-volume paracentesis. Patients with a poor response to medication or those who need frequent large-volume paracentesis (more than three times per week) or frequent hospitalization (more than three times per month) should be evaluated for liver transplantation or transjugular intrahepatic portosystemic shunt. α-Crystal rifaximin may become a new strategy for preventing complications of liver cirrhosis by regulating the intestine-microbe-liver axis. Therefore, it is of great significance to explore the"road map"of the diagnosis and treatment of intractable cirrhotic ascites that is suitable for the clinical practice in China.