PRACTICAL RECOMMENDATIONS FOR THE TREATMENT OF ASCITES AND ITS COMPLICATIONS

Ascites is one of the earliest and most common complications of patien ts with cirrhosis, and is associated with complications such as diluti onal hyponatraemia, renal dysfunction and spontaneous bacterial perito nitis. The treatment of ascites has been based on the combination of a low-sodium diet and the administration of diuretics. The reintroducti on of paracentesis and the recent introduction of the transjugular int rahepatic portosystemic shunt (TIPS) are the most relevant innovations in the treatment of ascites during the past 2 decades. The developmen t of ascites is closely related to renal disturbances of functional or igin, including the hepatorenal syndrome. A new definition of hepatore nal syndrome has been proposed recently and 2 different types have bee n defined (type I or progressive, and type II or stable). Although no effective therapy exists for this syndrome, the use of therapeutic met hods (TIPS, vasoconstrictor agents, dialysis) to temporarily improve r enal function and act as a 'bridge' to liver transplantation, may be o f most benefit. The use of potent and safe antibiotics has improved th e resolution rate and survival of patients with spontaneous bacterial peritonitis. In addition, the use of oral antibiotics will simplify th e management of this condition in the near future. Finally, prophylact ic antibiotic regimens represent a major step forwards in the preventi on of spontaneous bacterial peritonitis in subsets of cirrhotic patien ts with a great risk of developing this complication.