Effects of ursodeoxycholic acid on systemic, renal and forearm haemodynamics and sodium homoeostasis in cirrhotic patients with refractory ascites

1999 ◽  
Vol 96 (5) ◽  
pp. 467 ◽  
Author(s):  
Florence WONG ◽  
Arieh BOMZON ◽  
Johane ALLARD ◽  
Peter LIU ◽  
Laurence BLENDIS
Keyword(s):  
Ursodeoxycholic Acid ◽  
Refractory Ascites ◽  
Cirrhotic Patients

Effects of ursodeoxycholic acid on systemic, renal and forearm haemodynamics and sodium homoeostasis in cirrhotic patients with refractory ascites

1999 ◽  
Vol 96 (5) ◽  
pp. 467-474 ◽  
Author(s):  
Florence WONG ◽  
Arieh BOMZON ◽  
Johane ALLARD ◽  
Peter LIU ◽  
Laurence BLENDIS
Keyword(s):  
Lipid Peroxidation ◽  
Liver Function ◽  
Ursodeoxycholic Acid ◽  
Sodium Excretion ◽  
Refractory Ascites ◽  
Sodium Retention ◽  
Lipid Peroxidation Products ◽  
Cirrhotic Patients ◽  
Antioxidant Effects ◽  
Sodium Handling

Systemic arterial vasodilatation has been implicated in the pathogenesis of sodium retention in cirrhosis. Hydrophobic bile acids, which have vasodilatory actions, may be involved. Ursodeoxycholic acid, a hydrophilic bile acid, could potentially decrease systemic arterial vasodilatation, possibly due to its antioxidant effects, and improve sodium handling in cirrhosis. The effects of ursodeoxycholic acid on systemic, renal and forearm haemodynamics, liver function and renal sodium handling were assessed in vasodilated cirrhotic patients with refractory ascites treated with a transjugular intrahepatic porto-systemic shunt (TIPS). Eight cirrhotic patients with refractory ascites without TIPS placement served as controls for the sodium handling effects of ursodeoxycholic acid. From 1 month post TIPS, seven patients were studied before, after 1 month of treatment with ursodeoxycholic acid (15 mg·day-1·kg-1) and at 1 month follow-up. Lipid peroxidation products were used as indices of its antioxidant effects. Ursodeoxycholic acid caused a significant reduction in sodium excretion in both groups (P< 0.05). This, in the post-TIPS patients (urinary sodium excretion: 35±8 mmol/day at 1 month versus 93±21 mmol/day at baseline, P< 0.05), was due to a significant increase in sodium reabsorption proximal to the distal tubule (P< 0.05), without any significant changes in systemic, renal or forearm haemodynamics, or in liver function. No significant change in lipid peroxidation products was observed. We conclude that: (i) in cirrhotic patients with refractory ascites, ursodeoxycholic acid causes sodium retention, (ii) the abnormality in sodium handling in the post-TIPS cirrhotic patients appears to be the result of a direct effect on the proximal nephron, suggesting that factors other than systemic vasodilatation also contribute to sodium retention in cirrhosis, (iii) caution should be exercised in administering ursodeoxycholic acid in cirrhotic patients with ascites.

scholarly journals Transjugular Intrahepatic Portosystemic Shunt Placement for Portal Hypertension: Meta-Analysis of Safety and Efficacy of 8 mm vs. 10 mm Stents

2020 ◽  
Vol 2020 ◽  
pp. 1-10
Author(s):  
Jiangtao Liu ◽  
Eric Paul Wehrenberg-Klee ◽  
Emily D. Bethea ◽  
Raul N. Uppot ◽  
Kei Yamada ◽  
...  
Keyword(s):  
Overall Survival ◽  
Portal Hypertension ◽  
Transjugular Intrahepatic Portosystemic Shunt ◽  
Meta Analysis ◽  
Portosystemic Shunt ◽  
Refractory Ascites ◽  
Stent Group ◽  
Safety And Efficacy ◽  
Intrahepatic Portosystemic Shunt ◽  
Cirrhotic Patients

Introduction. Hepatic encephalopathy (HE) following transjugular intrahepatic portosystemic shunt (TIPS) placement remains a leading adverse event. Controversy remains regarding the optimal stent diameter given that smaller stents may decrease the amount of shunted blood and decrease the risk of HE, but stent patency and/or clinical adequacy of portal decompression may also be affected. We aim to provide meta-analysis-based evidence regarding the safety and efficacy of 8 mm vs. 10 mm stents during TIPS placement. Methods. PubMed, Embase, Cochrane Library, and Web of Science were searched for studies comparing 8 mm and 10 mm stents during TIPS placement for portal hypertension decompression in cirrhotic patients. Randomized controlled trials and cohort studies were prioritized for inclusion. Overall evaluation of quality and bias for each study was performed. The outcomes assessed were the prevalence of HE, rebleeding or failure to control refractory ascites, and overall survival. Subgroup analysis based on TIPS indication was conducted. Results. Five studies with a total number of 489 cirrhotic patients were identified. The pooled hazard ratio (HR) of post-TIPS HE was significantly lower in patients in the 8 mm stent group than in the 10 mm stent group (HR: 0.68, 95% CI: 0.51~0.92, p value < 0.0001). The combined HR of post-TIPS rebleeding/the need for paracentesis was significantly higher in patients in the 8 mm stent group than in the 10 mm stent group (HR: 1.76, 95% CI: 1.22~2.55, p value < 0.0001). There was no statistically significant difference in the overall survival between the 8 mm and 10 mm stent groups. The combined risk of HE in the variceal bleeding subgroup was statistically lower (HR: 0.52, CI: 0.34-0.80) with an 8 mm stent compared with a 10 mm stent. The combined risk of both rebleeding/paracentesis and survival was not statistically significant between 8 mm and 10 mm stent use in subgroup analysis. Conclusion. 8 mm stents during TIPS placement are associated with a significant lower risk of HE compared to 10 mm stents (32% decreased risk), as well as a 76% increased risk of rebleeding/paracentesis. Meta-analysis results suggest that there is not one superior stent choice for all clinical scenarios and that the TIPS indication of variceal bleeding or refractory ascites might have different appropriate selection of the shunt diameter.

Oral furosemide-induced natriuresis: a potential method for identifying cirrhotic patients with refractory ascites

2010 ◽  
Vol 30 (9) ◽  
pp. 1395-1395
Author(s):  
Jannis Kountouras ◽  
Christos Zavos ◽  
Lazaros Touloumis ◽  
Dimitrios Chatzopoulos
Keyword(s):  
Potential Method ◽  
Refractory Ascites ◽  
Cirrhotic Patients

scholarly journals Human Amnion-Derived Mesenchymal Stromal Cells in Cirrhotic Patients with Refractory Ascites: A Possible Anti-Inflammatory Therapy for Preventing Spontaneous Bacterial Peritonitis

2021 ◽  
Author(s):  
Mariangela Pampalone ◽  
Simona Corrao ◽  
Giandomenico Amico ◽  
Giampiero Vitale ◽  
Rossella Alduino ◽  
...  
Keyword(s):  
Ascitic Fluid ◽  
Mesenchymal Stromal Cells ◽  
Stromal Cells ◽  
Spontaneous Bacterial Peritonitis ◽  
Refractory Ascites ◽  
M2 Macrophage ◽  
Human Amnion ◽  
Bacterial Peritonitis ◽  
Cirrhotic Patients ◽  
Anti Inflammatory

AbstractCirrhosis is associated with dysregulated immune cell activation and immune dysfunction. These conditions modify gut flora, facilitate bacterial translocation, and increase susceptibility to bacterial peritonitis and consequent systemic infections by dramatically affecting long-term patient survival. Human amnion-derived mesenchymal stromal cells (hA-MSCs) exert immunomodulatory potential benefit, and have the ability to modulate their actions, especially in situations requiring immune activation through mechanisms not fully understood. In this study, we aimed to investigate, in vitro, the immunostimulant or immunosuppressive effects of hA-MSCs on cellular components of ascitic fluid obtained from cirrhotic patients with refractory ascites. We found that hA-MSCs viability is not affected by ascitic fluid and, interestingly, hA-MSCs diminished the pro-inflammatory cytokine production, and promoted anti-inflammatory M2 macrophage polarization. Moreover, we found that there was no simultaneous significant decrease in the M1-like component, allowing a continual phagocytosis activity of macrophages and NK cells to restore a physiological condition. These data highlight the plasticity of hA-MSCs’ immunomodulatory capacity, and pave the way to further understanding their role in conditions such as spontaneous bacterial peritonitis. Graphical abstract

scholarly journals P38 Homodynamic effects of prolonged treatment with midodrine in non-azotemic pre-ascitic, ascitic and refractory ascites cirrhotic patients

Gut ◽  
2011 ◽  
Vol 60 (Suppl 2) ◽  
pp. A18-A18
Author(s):  
H. Badran ◽  
A. Moaty ◽  
A. A. Basuni ◽  
W. F. A. Aziz ◽  
E. A. Rewisha ◽  
...  
Keyword(s):  
Prolonged Treatment ◽  
Refractory Ascites ◽  
Cirrhotic Patients

scholarly journals Automated low-flow ascites pump for the treatment of cirrhotic patients with refractory ascites

2017 ◽  
Vol 10 (2) ◽  
pp. 283-292 ◽  
Author(s):  
Guido Stirnimann ◽  
Vanessa Banz ◽  
Federico Storni ◽  
Andrea De Gottardi
Keyword(s):  
Low Flow ◽  
Refractory Ascites ◽  
Organ Shortage ◽  
Efficacy And Safety ◽  
Novel Treatments ◽  
Intrahepatic Portosystemic Shunt ◽  
Cirrhotic Patients ◽  
Large Volume Paracentesis ◽  
Volume Controlled ◽  
Automated Low Flow

Cirrhotic patients with refractory ascites (RA) can be treated with repeated large volume paracentesis (LVP), with the insertion of a transjugular intrahepatic portosystemic shunt (TIPS) or with liver transplantation. However, side effects and complications of these therapeutic options, as well as organ shortage, warrant the development of novel treatments. The automated low-flow ascites pump (alfapump®) is a subcutaneously-implanted novel battery-driven device that pumps ascitic fluid from the peritoneal cavity into the urinary bladder. Ascites can therefore be aspirated in a time- and volume-controlled mode and evacuated by urination. Here we review the currently available data about patient selection, efficacy and safety of the alfapump and provide recommendations for the management of patients treated with this new method.

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