Therapy of ascites in patients with liver cirrhosis

Ascites ist the most common complication in patients with cirrhosis and signals an unfavourable prognosis with a two-year survival rate of only 50%. Treatment is based on sodium restriction to 3 (max. 5) g NaCl per day. Fluid restriction below 1.5 l per day is indicated only in the case of hyponatremia. When giving diuretics in addition (spironolacton max. 400 mg per day and a loop diuretic, e.g. furosemide max. 160 mg per day) approximately 90% of patients can be managed successfully. The remaining 10% of patients with refractory ascites may be treated by serial therapeutic paracenteses, peritoneovenous shunting, and probably TIPS-implantation. Symptomatic therapy, however, does not prolong survival. Therefore the further progress of the underlying liver disease should be stopped whenever possible (e. g. patients should be encouraged to stop drinking), in addition liver transplantation should be considered in lime in all eligible patients.