Guidelines on the management of ascites in cirrhosis.

Revised 28 April 2006 Accepted for publication 28 April 2006 . . . . . . . . . . . . . . . . . . . . . . . 1.0 INTRODUCTION Ascites is a major complication of cirrhosis, occurring in 50% of patients over 10 years of follow up. The development of ascites is an important landmark in the natural history of cirrhosis as it is associated with a 50% mortality over two years, and signifies the need to consider liver transplantation as a therapeutic option. The majority (75%) of patients who present with ascites have underlying cirrhosis, with the remainder being due to malignancy (10%), heart failure (3%), tuberculosis (2%), pancreatitis (1%), and other rare causes. The true prevalence and incidence of cirrhosis of the liver and its complications in the UK are unknown. Mortality from cirrhosis has increased from 6 per 100 000 population in 1993 to 12.7 per 100 000 population in 2000. Approximately 4% of the general population have abnormal liver function or liver disease and approximately 10–20% of those with one of the three most common chronic liver diseases (non-alcoholic fatty liver disease, alcoholic liver disease, and chronic hepatitis C) develop cirrhosis over a period of 10–20 years. With a rising frequency of alcoholic and non-alcoholic fatty liver disease, a huge increase in the burden of liver disease is expected over the next few years with an inevitable increase in the complications of cirrhosis. There have been several changes in the clinical management of cirrhotic ascites over recent years, and the purpose of these guidelines is to promote a consistent clinical practice throughout the UK. These guidelines are based on a comprehensive literature search, including the results of randomised control trials, systematic reviews, prospective retrospective studies and, in some instances, evidence obtained from expert committee reports. Where possible a judgement is made on the quality of the information used to generate the guidelines, and the specific recommendations have been graded according to the Oxford Centre for Evidence-based Medicine Levels of Evidence (May 2001) (see appendices 1 and 2). These guidelines conform to the international guidelines recently published by the International Ascites Club and are intended for use by physicians. We hope to revise these guidelines in three years time.