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Rifaximin improves survival in cirrhotic patients with refractory ascites: A real-world study

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World Journal of Gastroenterology 2020年第2期26卷 199-218页

作者： Xin-Yue Lv Hui-Guo Ding Jun-Fu Zheng Chun-Lei Fan Lei Li Department of Gastroenterology and Hepatology Beijing You An Hospital Capital Medical University

BACKGROUND Rifaximin has been shown to reduce the incidence of hepatic encephalopathy and other complications in patients with ***,few studies have investigated the effect of rifaximin in cirrhotic patients with refractory *** To evaluate the effects of rifaximin in the treatment of refractory ascites and to preliminarily explore its possible *** A total of 75 cirrhotic patients with refractory ascites were enrolled in the study(50 in a rifaximin and 25 in a control group).Patients in the rifaximin group were divided into two subgroups according to the presence of spontaneous bacterial peritonitis and treatment with or without other antibiotics(19 patients treated with rifaximin and 31 patients treated with rifaximin plus intravenous antibiotics).All patients received conventional treatment for refractory ascites,while patients in the rifaximin group received oral rifaximin-α200 mg four times daily for at least 2 *** ascites grade,fasting weight,liver and kidney function,and inflammatory factors in the plasma were evaluated before and after *** addition,the gut microbiota was determined by metagenomics sequencing to analyse the changes in the characteristics of the gut microbiota before and after rifaximin *** patients were followed for 6 *** Compared with the control group,the fasting weight of patients significantly decreased and the ascites significantly subsided after treatment with rifaximin(P=0.011 and 0.009,respectively).The 6-mo survival rate of patients in the rifaximin group was significantly higher than that in the control group(P=0.048).The concentration of interferon-inducible protein 10 decreased significantly in the rifaximin group compared with that in the control group(P=0.024).The abundance of Roseburia,Haemophilus,and Prevotella was significantly reduced after rifaximin treatment,while the abundance of Lachnospiraceae_noname,Subdoligranulum,and Dorea decreased and the abundance of Co

关键词： Rifaximin Cirrhosis refractory ascites Inflammatory factors Gut microbiota Metagenomics sequencing

Clinical efficacy of tolvaptan for treatment of refractory ascites in liver cirrhosis patients

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World Journal of Gastroenterology 2014年第32期20卷 11400-11405页

作者： Xin Zhang Shu-Zhen Wang Jun-Fu Zheng Wen-Min Zhao Peng Li Chun-Lei Fan Bing Li Pei-Ling Dong Lei Li Hui-Guo Ding Department of Gastroenterology and Hepatology Beijing You’an Hospital Affiliated with Capital Medical University

AIM: To evaluate the efficacy and safety of tolvaptan to treat refractory ascites in decompensated liver cirrhosis patients with or without further complications, such as hepatorenal syndrome and/or hepatocellular car... 详细信息

关键词： Tolvaptan refractory ascites Hyponatremia Decompensation Liver cirrhosis

Constrictive pericarditis as a cause of refractory ascites after liver transplantation:A case report

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World Journal of Clinical Cases 2019年第20期7卷 3266-3270页

作者： Miran Bezjak Branislav Kocman Stipislav Jadrijevic Hrvoje Gasparovic Anna Mrzljak Tajana Filipec Kanizaj Darko Vujanic Tomislav Bubalo Danko Mikulic Division of Abdominal Surgery and Organ Transplantation Department of SurgeryUniversity Hospital MerkurZagreb 10000Croatia Division of Cardiology Department of Internal MedicineUniversity Hospital Centre ZagrebZagreb 10000Croatia Division of Gastroenterology Department of Internal MedicineUniversity Hospital MerkurZagreb 10000Croatia Division of Cardiology Department of Internal MedicineUniversity Hospital MerkurZagreb 10000Croatia

BACKGROUND refractory ascites is a rare complication following orthotopic liver transplantation(OLT).The broad spectrum of differential diagnosis often leads to delay in *** depends on recognition and treatment of the underlying *** pericarditis is a condition characterized by clinical signs of right-sided heart *** the advanced stages of the disease,hepatic congestion leads to formation of *** patients after OLT,cardiac etiology of ascites is easily overlooked and it requires a high degree of clinical *** SUMMARY We report a case of a 55-year-old man who presented with a refractory ascites three months after liver transplantation for alcoholic *** to transplantation the patient had a minimal amount of *** transplant procedure and the early postoperative course were *** posttransplant work up failed to reveal any typical cause of refractory post-transplant *** function of the graft was *** from atrial fibrillation,cardiac status was *** months post transplantation the patient developed dyspnea and severe fatigue with peripheral *** was still *** presenting signs of right-sided heart failure were highly suggestive of cardiac *** paracentesis was suggestive of cardiac ascites,and further cardiac evaluation showed typical signs of constrictive *** was performed followed by complete resolution of *** the follow-up the patient remained symptom-free with no signs of recurrent ascites and with normal function of the liver *** refractory ascites following liver transplantation is a rare complication with many possible *** differential diagnosis needs to be considered.

关键词： Constrictive pericarditis Liver transplantation refractory ascites Case report

Portal Hypertension refractory ascites Caused by Secondary Hemochromatosis

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Journal of Clinical and Translational Hepatology 2023年第4期11卷 987-990页

作者： Jun Tie Wen Yuan Jia Xiaoyuan Gou State Key Laboratory of Cancer Biology National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive DiseasesXijing HospitalAir Force Medical UniversityXi’anShaanxiChina

We report a patient with refractory ascites because of portal hypertension caused by hemochromatosis secondary to *** our knowledge,this is the first well-documented case of this association.A 46-year-old male patient who was repeatedly infused with red blood cells for anemia secondary to osteopetrosis suffered from refractory *** serum-ascites albumin gradient was 29.9 g/*** computed tomography(CT)showed a large amount of ascites,hepatomegaly,and *** marrow biopsy showed a small bone marrow cavity with no hematopoietic tissue.A peripheral blood smear showed tear drop red blood cells and *** ferritin was 8,855.0 ng/***,we considered that the ascites resulted from portal hypertension caused by hemochromatosis secondary to *** simultaneously performed the transjungular intrahepatic portal-systemic shunt(TIPS)and obtained a transjungular liver *** portal pressure gradient before TIPS was 28 mmHg,and iron staining was strongly positive on liver biopsy,which confirmed our *** TIPS,both abdominal distention and ascites gradually resolved,and no recurrence as observed after the 12-month postoperative follow-up was *** case indicated that regular monitoring of iron load is important for patients with *** is safe and effective for portal hypertension complications due to osteopetrosis.

关键词： refractory ascites Secondary hemochromatosis Osteopetrosis Transjugular intrahepatic portosystemic shunt Case report

Prevalence and risk factors of lymphatic dysfunction in cirrhosis patients with refractory ascites:An often unconsidered mechanism

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World Journal of Hepatology 2023年第10期15卷 1140-1152页

作者： Rahul Arya Ramesh Kumar Tarun Kumar Sudhir Kumar Utpal Anand Rajeev Nayan Priyadarshi Tanmoy Maji Department of Gastroenterology All India Institute of Medical SciencesPatna 801507BiharIndia Department of Pathology All India Institute of Medical SciencesPatna 801507BiharIndia Department of Surgical Gastroenterology All India Institute of Medical SciencesPatna 801507BiharIndia Department of Radiodiagnosis All India Institute of Medical SciencesPatna 801507BiharIndia

BACKGROUND The lymphatic system is crucial in maintaining the body fluid homeostasis.A dysfunctional lymphatic system may contribute to the refractoriness of ascites and edema in cirrhosis ***,assessment of lymphatic dysfunction in cirrhosis patients with refractory ascites(RA)can be crucial as it would call for using different strategies for fluid *** To assessing the magnitude,spectrum,and clinical associations of lymphatic dysfunction in liver cirrhosis patients with *** This observational study included 155 consecutive cirrhosis patients with *** presence of clinical signs of lymphedema,such as peau d’orange appearance and positive Stemmer sign,intestinal lymphangiectasia(IL)on duodenal biopsy seen as dilated vessels in the lamina propria with strong D2-40 immunohistochemistry,and chylous ascites were used to diagnose the overt lymphatic *** A total of 69(44.5%)patients out of 155 had evidence of lymphatic *** lymphedema,found in 52(33.5%)patients,was the most common manifestation,followed by IL in 42(27.0%)patients,and chylous ascites in 2(1.9%)*** to patients without lymphedema,those with lymphedema had higher mean age,median model for end-stage liver disease scores,mean body mass index,mean ascitic fluid triglyceride levels,and proportion of patients with hypoproteinemia(serum total protein<5 g/dL)and lymphocytopenia(<15%of total leukocyte count).Patients with IL also had a higher prevalence of lymphocytopenia and hypoproteinemia(28.6%vs.9.1%,P=0.004).Seven(13%)patients with lymphedema had lower limb cellulitis compared to none in those without *** multivariate regression analysis,factors independently associated with lymphatic dysfunction included obesity[odds ratio(OR):4.2,95%confidence intervals(95%CI):1.1–15.2,P=0.027],lymphocytopenia[OR:6.2,95%CI:2.9–13.2,P<0.001],and hypoproteinemia[OR:3.7,95%CI:1.5–8.82,P=0.003].CONCLUSION Lymphatic dysfunction is common in cirrho

关键词： Cirrhosis Lymphedema Lymphangicetasia refractory ascites Chylous ascites Lymphocytopenia

Alfapump®implantable device in management of refractory ascites:An update

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World Journal of Hepatology 2022年第7期14卷 1344-1356页

作者： Delphine Weil-Verhoeven Vincent Di Martino Guido Stirnimann Jean Paul Cervoni Eric Nguyen-Khac Thierry Thévenot Service d’Hépatologie Et Soins Intensifs Digestifs CHRU Jean MinjozBesançon 25030France EA 4266 EPILAB Universitéde Bourgogne Franche-ComtéBesançon 25030France Department of Visceral Surgery and Medicine Inselspital University Hospital and University of BernBern 3010Switzerland Service d’Hépato-Gastroentérologie CHU Amiens-PicardieAmiens 80080France

refractory ascites(RA)is a frequent and life-threatening complication of *** selected patients with RA,transjugular intrahepatic portosystemic shunt(TIPS)placement and liver transplantation(LT)are currently considered the best therapeutic alternatives to repeated large volume *** patients with a contraindication to TIPS or LT,the alfapump®system(Sequana Medical,Ghent,Belgium)has been developed to reduce the need for iterative paracentesis,and consequently to improve the quality of life and nutritional *** report here recent data on technical progress made since the first implantation,the efficacy and tolerance of the device,the position of the pump in the therapeutic arsenal for refractory ascites,and the grey areas that remain to be clarified regarding the optimal selection of patients who are potential candidates for this treatment.

关键词： Alfapump refractory ascites Automated low flow ascites pump Cirrhosis Liver

Clinical research on navel application of Shehuang Paste combined with Chinese herbal colon dialysis in treatment of refractory cirrhotic ascites complicated with azotemia

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World Journal of Gastroenterology 2006年第48期12卷 7798-7804页

作者： Guang-Dong Tong Da-Qiao Zhou Jing-Song He Lai Zhang Zhi-Fei Chen Chun-Ling Xiao Li-Sheng Peng Department of Hepatology Shenzhen Hospital of Traditional Chinese MedicineGuangzhou University of TCM Shenzhen 518033 GuangdongProvince China

AIM: To explore the efficacy and mechanism of a novel therapeutic method of traditional Chinese medicine in patients with refractory cirrhotic ascites complicated with azotemia. METHODS: Seventy-five cases of refractory cirrhotic ascites complicated with azotemia were randomly divided into 3 groups: comprehensive treatment (n = 29), simple treatment (n = 24), and control (n = 22). The basic treatment methods were the same in all groups, including liver protecting medicines, diuretics and supportive drugs. The control group underwent only the basic treatment. Shehuang Paste (SHP) was applied to the navels of the two treatment groups once a day for 30 d. Colon dialysis with Chinese herbs was administered to the comprehensive treatment group once every two days. Before and after treatment, we measured abdominal circumference, BUN, Cr, serum Na+, urine Na+/K+, liver function, endotoxin content, NO, and ET-1. Color Doppler ultrasonography was conducted to measure the portal vein blood flow. RESULTS: The total effective rate for ascites was 72.4% in the comprehensive treatment group, 45.8% in the simple treatment, contrasting with 18.2% in the controls. Between the two treatment groups and the controls, there were significant differences in the effective rates (P 0.05).

关键词： Cirrhotic refractory ascites Azotemia Vasoactive substance

Effects of Shehuang Paste (麝黄膏) on Hemodynamics, Endotoxin, Nitric Oxide and Endothelin-1 in Patients with refractory Cirrhotic ascites

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Chinese Journal of Integrative Medicine 2006年第4期12卷 255-261页

作者：童光东周大桥贺劲松李松林彭立生 Department of Hepatology Shenzhen Hospital of Traditional Chinese Medicine Affiliated to Guangzhou University of Traditional Chinese Medicine Guangdong (518033)

Objective： To explore the influence of Shehuang Paste （麝黄膏, SHP） to the hemodynamics, endotoxin, nitric oxide （NO）, and endothelin-1 （ET-1） in patients with refractory cirrhotic ascites. Methods： Fifty-nine cases of refractory cirrhotic ascites were randomly assigned to two groups, 32 cases in the treatment group and 27 cases in the control group. The basic treatment was the same for both groups, including liver protecting medicines, diuretics and supportive drugs, but SHP navel sticking was applied for the treatment group additionally once a day. A course of one month of treatment was applied and the general efficacy on ascites was observed by the end of the therapeutic course. Before and after the treatment, examinations by limulus lysate chromogenic test was conducted to measure plasma endotoxin content; colorimetry to measure plasma content of NO indirectly, radioimmunoassay to measure plasma ET-1 content; and color Doppler ultrasonography to measure the blood flow of portal vein and splenic vein. The relationship between the blood flow of portal vein and splenic vein and endotoxin, NO and ET-1 in the treatment group was analyzed as well. Results： The total effective rate on ascites was 84.4% in the treatment group, and 48. 1% in the control group, with significant difference shown between them （P〈0.01）. In the treatment group the blood flow of portal vein and splenic vein, contents of endotoxin, NO and ET-1 all got significantly reduced after treatment （ P〈0.05 or P〈0.01）; while these indexes in the control group were not significantly changed （P〉0.05）. Moreover, it was found that in the treatment group, the blood flow of portal vein and splenic vein had a positive correlation to the levels of NO, ET-1, and endotoxin, either before or after treatment. Conclusion： Application of SHP navel sticking could clearly reduce the blood flow of portal vein and splenic vein, and lower the content of endotoxin, NO and ET-1. The blood flow of portal vein and splenic vein in

关键词： liver cirrhosis refractory ascites vasoactive substance hemodynamics

Pathophysiology and Prevention of Paracentesis-induced Circulatory Dysfunction:A Concise Review

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Journal of Clinical and Translational Hepatology 2020年第1期8卷 42-48页

作者： Anand V Kulkarni Pramod Kumar Mithun Sharma T R Sowmya Rupjyoti Talukdar Padaki Nagaraj Rao D Nageshwar Reddy Department of Hepatology Asian Institute of GastroenterologyHyderabadIndia Department of Gastroenterology Asian Institute of GastroenterologyHyderabadIndia

Annually,10%of cirrhotic patients with ascites develop refractory ascites for which large-volume paracentesis(LVP)is a frequently used therapeutic ***,although a safe method,is associated with circulatory dysfunction in a significant percentage of patients,which is termed para-centesis-induced circulatory dysfunction(PICD).PICD results in faster reaccumulation of ascites,hyponatremia,renal impairment,and shorter *** is diagnosed through laboratory results,with increases of>50%of baseline plasma renin activity to a value≥4 ng/mL/h on the fifth to sixth day after *** this review,we discuss the pathophysi-ology and prevention of PICD.

关键词： refractory ascites Plasma renin activity Large-volume paracentesis Cirrhosis Portal hypertension