Ascites is one of the earliest and most common complications of patients with
cirrhosis, and is associated with complications such as dilutional hyponatraemia, renal dysfunction and spontaneous bacterial
peritonitis. The treatment of
ascites has been based on the combination of a
low-sodium diet and the administration of
diuretics. The reintroduction of paracentesis and the recent introduction of the transjugular intrahepatic
portosystemic shunt (
TIPS) are the most relevant innovations in the treatment of
ascites during the past 2 decades. The development of
ascites is closely related to renal disturbances of functional origin, including the
hepatorenal syndrome. A new definition of
hepatorenal syndrome has been proposed recently and 2 different types have been defined (type I or progressive, and type III or stable). Although no effective
therapy exists for this syndrome, the use of therapeutic methods (
TIPS,
vasoconstrictor agents, dialysis) to temporarily improve renal function and act as a 'bridge' to
liver transplantation, may be of most benefit. The use of potent and safe
antibiotics has improved the resolution rate and survival of patients with spontaneous bacterial
peritonitis. In addition, the use of oral
antibiotics will simplify the management of this condition in the near future. Finally, prophylactic
antibiotic regimens represent a major step forwards in the prevention of spontaneous bacterial
peritonitis in subsets of cirrhotic patients with a great risk of developing this complication.