Article Text

Guidelines on the management of ascites in cirrhosis
  1. Guruprasad P Aithal1,2,
  2. Naaventhan Palaniyappan1,2,
  3. Louise China3,
  4. Suvi Härmälä4,
  5. Lucia Macken5,6,
  6. Jennifer M Ryan3,7,
  7. Emilie A Wilkes2,8,
  8. Kevin Moore3,
  9. Joanna A Leithead9,
  10. Peter C Hayes10,
  11. Alastair J O'Brien3,
  12. Sumita Verma5,6
  1. 1 NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
  2. 2 Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, Nottingham, UK
  3. 3 Institute of Liver Disease and Digestive Health, University College London, London, UK
  4. 4 Institute of Health Informatics, University College London, London, UK
  5. 5 Department of Clinical and Experimental Medicine, Brighton and Sussex Medical School, Brighton, UK
  6. 6 Department of Gastroenterology and Hepatology, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
  7. 7 Royal Free London NHS Foundation Trust, London, UK
  8. 8 Nottingham University Hospitals NHS Trust, Nottingham, UK
  9. 9 Liver Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
  10. 10 Hepatology Department, Royal Infirmary of Edinburgh, Edinburgh, UK
  1. Correspondence to Professor Guruprasad P Aithal, NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham NG7 2UH, UK; guru.aithal{at}


The British Society of Gastroenterology in collaboration with British Association for the Study of the Liver has prepared this document. The aim of this guideline is to review and summarise the evidence that guides clinical diagnosis and management of ascites in patients with cirrhosis. Substantial advances have been made in this area since the publication of the last guideline in 2007. These guidelines are based on a comprehensive literature search and comprise systematic reviews in the key areas, including the diagnostic tests, diuretic use, therapeutic paracentesis, use of albumin, transjugular intrahepatic portosystemic stent shunt, spontaneous bacterial peritonitis and beta-blockers in patients with ascites. Where recent systematic reviews and meta-analysis are available, these have been updated with additional studies. In addition, the results of prospective and retrospective studies, evidence obtained from expert committee reports and, in some instances, reports from case series have been included. Where possible, judgement has been made on the quality of information used to generate the guidelines and the specific recommendations have been made according to the ‘Grading of Recommendations Assessment, Development and Evaluation (GRADE)’ system. These guidelines are intended to inform practising clinicians, and it is expected that these guidelines will be revised in 3 years’ time.

  • ascites
  • cirrhosis

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  • Contributors GA: senior author. NP: co-author (TIPSS, hepatic hydrothorax). LC: co-author (albumin in ascites). SH: co-author (albumin in ascites). LM: co-author (paracentesis). JMR: co-author (spontaneous bacterial peritonitis). EAW: co-author (diagnostic paracentesis). KM: senior author. JAL: co-author (beta-blockers in ascites). PCH: senior author (beta-blockers in ascites). AJO: senior author (albumin in ascites). SV: senior author (diuretics, palliative care). All authors reviewed and approved the final document.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests SV and LM: Received support from Rocket Medical for the NIHR funded REDUce Study.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.