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Chinese guidelines on the management of ascites and its related complications in cirrhosis

Ascites, a common complication of decompensated cirrhosis, are known to contribute to reduced survival.

This article provides evidence-based recommendations by the Chinese Society of Hepatology for the prevention and treatment of ascites and ascites-related complications.

The first of their kind in China, these recommendations adapt guidelines issued by medical societies and/or regulatory bodies in other countries to the specific reality of the patient characteristics and healthcare system in this territory.

The article specifically covers the pathogenesis, diagnosis, grading and typing, as well as the management of cirrhotic ascites triggered by portal hypertension, spontaneous bacterial peritonitis with no obvious cause of intra-abdominal lesion, and hepatorenal syndrome, which manifests as renal impairment with cirrhosis complicated with ascites.

Overall, treatment should follow a stepwise approach based on the volume of ascites and the specific clinical manifestations at each stage of the disease.

The evidence supporting the use of vasoconstrictors and albumin in refractory ascites and vasopressors and albumin in hepatorenal syndrome is described. The recommendations for empirical antimicrobial therapy to treat spontaneous bacterial peritonitis are based on data on community- and hospital-acquired infections at the local level.

The article also reviews adequate procedures in case of non-response and discontinuation and current knowledge gaps.