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Ascites

Abnormal buildup of fluid in the abdomen that may cause swelling. In late-stage cancer, tumor cells may be found in the fluid in the abdomen. Ascites also occurs in patients with liver disease.

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(Source: NIH - National Cancer Institute)

What works? Research summarized

Evidence reviews

Existing trials, of poor quality, indicate that antibiotic prophylaxis reduces spontaneous bacterial peritonitis among cirrhotic patients with ascites and no gastrointestinal bleeding

Spontaneous bacterial peritonitis (infection and inflammation of the membrane lining the abdominal cavity) is a frequent complication among cirrhotic patients (patients with end‐stage liver disease marked by irreversible scarring of liver tissue) and is associated with significant morbidity and mortality. Selective intestinal decontamination, employing antibiotics, is a proposed prophylactic (preventive) measure. This systematic review of randomised clinical trials assesses whether antibiotic prophylaxis prevents spontaneous bacterial peritonitis and mortality among cirrhotic patients with ascites (excess fluid in the abdominal cavity) and no gastrointestinal bleeding. Nine trials are included in the review. The pooled rates of spontaneous bacterial peritonitis and mortality indicate that antibiotic prophylaxis reduces both. There are very few reports of adverse events. Reviewing these trials, we found poor methodology, evidence suggesting publication bias, and limited follow‐up periods. Thus, the recommendation to prescribe prophylactic antibiotics to cirrhotic patients without gastrointestinal bleeding is hampered by quality of the trials that generated the data. Due to potential hazards, both to society as a whole and the patients, as individuals, before antibiotic prophylaxis can be confidently recommended, trials of better design, well reported, and of longer follow‐up are required.

Patients with refractory ascites may temporarily benefit from transjugular intrahepatic portosystemic stent‐shunts

Refractory ascites causes substantial morbidity in patients with cirrhosis. Randomised trials have compared transjugular intrahepatic portosystemic stent‐shunts with paracentesis. Mortality, gastrointestinal bleeding, renal failure, or infection did not differ significantly between the two intervention groups. Transjugular intrahepatic portosystemic stent‐shunts effectively decreased the risk of ascites fluid re‐accumulation, but was associated with an increased risk of hepatic encephalopathy.

Diagnostic value of vascular endothelial growth factor in differentiation of malignant ascites: a meta-analysis

Bibliographic details: Lv XG, Dong WG, Zhan N, Lei XF, Tian Z, Hua Y, Shen XF.  Diagnostic value of vascular endothelial growth factor in differentiation of malignant ascites: a meta-analysis. Chinese Journal of Evidence-Based Medicine 2011; 11(2): 220-225 Available from: http://www.cjebm.org.cn/en/oa/DArticle.aspx?type=view&id=201102017

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Summaries for consumers

Existing trials, of poor quality, indicate that antibiotic prophylaxis reduces spontaneous bacterial peritonitis among cirrhotic patients with ascites and no gastrointestinal bleeding

Spontaneous bacterial peritonitis (infection and inflammation of the membrane lining the abdominal cavity) is a frequent complication among cirrhotic patients (patients with end‐stage liver disease marked by irreversible scarring of liver tissue) and is associated with significant morbidity and mortality. Selective intestinal decontamination, employing antibiotics, is a proposed prophylactic (preventive) measure. This systematic review of randomised clinical trials assesses whether antibiotic prophylaxis prevents spontaneous bacterial peritonitis and mortality among cirrhotic patients with ascites (excess fluid in the abdominal cavity) and no gastrointestinal bleeding. Nine trials are included in the review. The pooled rates of spontaneous bacterial peritonitis and mortality indicate that antibiotic prophylaxis reduces both. There are very few reports of adverse events. Reviewing these trials, we found poor methodology, evidence suggesting publication bias, and limited follow‐up periods. Thus, the recommendation to prescribe prophylactic antibiotics to cirrhotic patients without gastrointestinal bleeding is hampered by quality of the trials that generated the data. Due to potential hazards, both to society as a whole and the patients, as individuals, before antibiotic prophylaxis can be confidently recommended, trials of better design, well reported, and of longer follow‐up are required.

Patients with refractory ascites may temporarily benefit from transjugular intrahepatic portosystemic stent‐shunts

Refractory ascites causes substantial morbidity in patients with cirrhosis. Randomised trials have compared transjugular intrahepatic portosystemic stent‐shunts with paracentesis. Mortality, gastrointestinal bleeding, renal failure, or infection did not differ significantly between the two intervention groups. Transjugular intrahepatic portosystemic stent‐shunts effectively decreased the risk of ascites fluid re‐accumulation, but was associated with an increased risk of hepatic encephalopathy.

Methods for the drainage of fluid containing cancer cells that collect in the abdomen in women with a gynaecological cancer

Patients with advanced ovarian cancer and some patients with advanced endometrial cancer often need repeated drainage for malignant ascites. Guidelines to advise those involved in the drainage of ascites are usually produced locally and are generally not evidence‐based but mainly based on clinicians' anecdotal evidence and experience.

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More about Ascites

Photo of an adult

Also called: Hydroperitoneum, Fluid in peritoneal cavity, Hydroperitonia, Abdominal dropsy, Hydrops abdominis, Peritoneal dropsy

Other terms to know:
Cavity, Edema, Peritoneal Cavity

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