Management of ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome in cirrhosis

The peer reviewed guidelines will be available in the September 2010 issue, (Volume 53, No.3) of the Journal of Hepatology and online in advance of publication at http://www.ncbi.nlm.nih.gov/pubmed/20633946 . They also provide recommendations for the management of spontaneous bacterial peritonitis (SBP) and hepatorenal syndrome, which often affect patients with cirrhosis .

An estimated 75 percent of patients presenting with ascites in Western Europe and the USA have cirrhosis as the underlying cause. The development of ascites is an extremely common yet debilitating complication for cirrhotic patients and has a huge impact on their life expectancy and quality of life. SBP and hepatorenal syndrome are ominous complications of which patients with ascites are at risk. They carry a high mortality and prophylactic measures, early diagnosis and appropriate treatments are crucial, especially to bridge eligible patients to liver transplantation.

"It is estimated that almost 60 percent of cirrhotic patients develop ascites within 10 years of their disease, which is a huge proportion of patients. These guidelines provide clinicians with the latest recommendations from a panel of experts on the management of ascites, SBP and hepatorenal syndrome. It is hoped that the guidelines will improve and facilitate best practice and ultimately improve disease outcomes and symptoms for cirrhotic patients in the future," stated Pere Ginčs, lead contributor of the guidelines.

These guidelines aim to assist clinicians in the decision making and management process for ascites, SBP and hepatorenal syndrome, as well as inform patients and their carers of optimal treatment and care. New and updated best practice for the screening, diagnosis and management of these conditions are offered, with particular emphasis on:

• Prevalence and prognosis of ascites
  
• Management of the various stages of its development
  
• Diagnostic strategies for ascites, SBP and hepatorenal syndrome
  
• The use of drugs, antibiotics and diuretics and their associated complications
  
• Ascitic fluid analysis for assessing peritoneal infections
  
• Methods to improve renal function and considerations of liver transplantation

"EASL is dedicated to promoting research and education in the field of hepatology to improve the treatment of liver disease throughout the world. Its series of clinical practice guidelines aims to promote best practise to drive better clinical outcomes and inform both the scientific community and the wider public of the latest developments in the field. We hope these new ascites guidelines provide clinicians with the most up-to-date, evidence based methods for the management of patients affected by this common and debilitating disease" added Professor Heiner Wedemeyer, EASL Secretary General.

Provided by European Association for the Study of the Liver