Guidelines on the management of ascites in cirrhosis

Gut - Tập 70 Số 1 - Trang 9-29 - 2021
Guruprasad P. Aithal1, Naaventhan Palaniyappan2,3, Louise China4, Suvi Härmälä5, Lucia Macken6,7, Jennifer Ryan4,8, Emilie Wilkes3,9, Kevin Moore4, Joanna A Leithead10, Peter C. Hayes11, Alastair O’Brien4, Sumita Verma6,7
1NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham NG7 2UH, UK
2NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
3Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, Nottingham, UK
4Institute of Liver Disease and Digestive Health, University College London, London, UK
5Institute of Health Informatics, University College London, London, UK
6Department of Clinical and Experimental Medicine, Brighton and Sussex Medical School, Brighton, UK
7Department of Gastroenterology and Hepatology, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
8Royal Free London NHS Foundation Trust, London, UK
9Nottingham University Hospitals NHS Trust, Nottingham, UK
10Liver Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
11Hepatology Department, Royal Infirmary of Edinburgh, Edinburgh, UK

Tóm tắt

The British Society of Gastroenterology in collaboration with British Association for the Study of the Liver has prepared this document. The aim of this guideline is to review and summarise the evidence that guides clinical diagnosis and management of ascites in patients with cirrhosis. Substantial advances have been made in this area since the publication of the last guideline in 2007. These guidelines are based on a comprehensive literature search and comprise systematic reviews in the key areas, including the diagnostic tests, diuretic use, therapeutic paracentesis, use of albumin, transjugular intrahepatic portosystemic stent shunt, spontaneous bacterial peritonitis and beta-blockers in patients with ascites. Where recent systematic reviews and meta-analysis are available, these have been updated with additional studies. In addition, the results of prospective and retrospective studies, evidence obtained from expert committee reports and, in some instances, reports from case series have been included. Where possible, judgement has been made on the quality of information used to generate the guidelines and the specific recommendations have been made according to the ‘Grading of Recommendations Assessment, Development and Evaluation (GRADE)’ system. These guidelines are intended to inform practising clinicians, and it is expected that these guidelines will be revised in 3 years’ time.

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