Guidelines on the management of ascites in cirrhosis

Aithal, Guruprasad P; Palaniyappan, Naaventhan; China, Louise; Härmälä, Suvi; Macken, Lucia; Ryan, Jennifer M; Wilkes, Emilie A; Moore, Kevin; Leithead, Joanna A; Hayes, Peter C; O"Brien, Alastair J; Verma, Sumita

doi:10.1136/gutjnl-2020-321790

Cited by 680Liver Disease and TransplantationHeart Failure Treatment and ManagementLiver Disease Diagnosis and Treatment

Guidelines on the management of ascites in cirrhosis

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Aithal, Guruprasad P, Palaniyappan, Naaventhan, China, Louise, Härmälä, Suvi, Macken, Lucia, Ryan, Jennifer M, Wilkes, Emilie A, Moore, Kevin +4 more·2021·Gut

DOI 10.1136/gutjnl-2020-321790PMC PMC7788190

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Abstract

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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Complex chronic liver diseases like cirrhosis, liver failure, and hepatocellular carcinoma demand meticulous patient selection for clinical research.
“In hepatology, the complexity of chronic diseases like cirrhosis, liver failure, and hepatocellular carcinoma demands meticulous patient selection for clinical research [1].”
From Enhancing hepatopathy clinical trial efficiency: a secure, large language model-powered pre-screening pipeline (2025) · cites this paper as [1]
The TIPSS > Patient selection section (page unavailable) says careful selection of patients with refractory ascites is vital and describes exclusions from seven randomized trials involving patients with cirrhosis. This supports the need for careful selection in that specific context, but not the broader claim about clinical research across cirrhosis, liver failure, and hepatocellular carcinoma. (LLM, conf=0.83)
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[151]Rowley MW, Cole L, Aguon PM, et al Ultrasound imaging guidance and large volume paracentesis: an analysis of safety, cost-effectiveness, and utility in restricting unnecessary transfusion. Hepatology 2018; 68: 568a.

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Authors: Aithal, G. P., Palaniyappan, N., China, L., Härmälä, S., Macken, L., Ryan, J. M., Wilkes, E. A., Moore, K., Leithead, J. A., Hayes, P. C., O"Brien, A. J., & Verma, S.
Affiliations: Nottingham University Hospitals NHS Trust (GB)
University College London (GB)
Brighton and Sussex Medical School (GB)
Royal Free London NHS Foundation Trust (GB)
Cambridge University Hospitals NHS Foundation Trust (GB)
Edinburgh Royal Infirmary (GB)
Corresponding author: Aithal, Guruprasad P
ORCID: Aithal, Guruprasad P
Palaniyappan, Naaventhan
China, Louise
Härmälä, Suvi
Macken, Lucia
Wilkes, Emilie A
Leithead, Joanna A
Hayes, Peter C
O"Brien, Alastair J
Verma, Sumita
Venue: Gut
Publisher: BMJ
Published: 2020-10-16
Volume: 70
Issue: 1
Pages: 9-29
ISSN: 0017-5749 (ISSN-L)
1468-3288
DOI: 10.1136/gutjnl-2020-321790
PMC: PMC7788190
OpenAlex: W2144187699
Cited by: 680
References: 430
Citations by year: 2026: 47 · 2025: 93 · 2024: 78 · 2023: 82 · 2022: 78 · 2021: 39 · 2020: 25 · 2019: 26 · 2018: 22 · 2017: 16 · 2016: 20 · 2015: 30 · 2014: 30 · 2013: 18 · 2012: 10
FWCI: 32.92
Type: journal article
Language: en
Open access: hybrid
doi.org
Licence: cc-by-nc
creativecommons.org/licenses/by-nc/4.0/ (unspecified)
Locations: Gut (publishedVersion, cc-by-nc)
PubMed Central (publishedVersion, cc-by-nc)
PubMed (publishedVersion)
Repository@Nottingham (University of Nottingham) (publishedVersion, cc-by-nc)
Repository@Nottingham (University of Nottingham) (submittedVersion, cc-by-nc)
Sussex Research Online (University of Sussex) (submittedVersion, cc-by-nc)
UCL Discovery (University College London) (submittedVersion)
Figshare (submittedVersion, cc-by-nc)
Apollo (University of Cambridge) (submittedVersion, cc-by-nc)
Apollo
Funders: Nottingham University Hospitals NHS Trust
National Institute for Health and Care Research (PB-PG-0214-33068, CL-2017-12-002)
Academy of Medical Sciences (SGL024\1044)
University of Nottingham
Topics: Health Sciences › Medicine › Hepatology › Liver Disease and Transplantation
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
Health Sciences › Medicine › Epidemiology › Liver Disease Diagnosis and Treatment
Keywords: ascites, liver cirrhosis, diuretics, therapeutic paracentesis, albumin, transjugular intrahepatic portosystemic shunt, spontaneous bacterial peritonitis, beta-blockers, portal hypertension
MeSH terms: Ascites, Humans, Liver Cirrhosis

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