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Guidelines on the management of ascites in cirrhosis
Open accessAbstract
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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![Figure 4 Anatomical landmarks for the safe performance of paracentesis [A] and performance of ascites drainage in patients with large ascites [B].](/paper-figures/4ed98f9680614268ab7890e0a525842b/guidelines-on-the-management-of-ascites-in-cirrhosis-figure-4.jpg)
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“In hepatology, the complexity of chronic diseases like cirrhosis, liver failure, and hepatocellular carcinoma demands meticulous patient selection for clinical research [1].”
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Metadata
- 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
- Venue
- Gut
- Publisher
- BMJ
- Published
- 2020-10-16
- Volume
- 70
- Issue
- 1
- Pages
- 9-29
- ISSN
- 0017-5749 (ISSN-L)
- 1468-3288
- 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
- FWCI
- 32.92
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- 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 › Hepatology › 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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