2023
Update in the Treatment of the Complications of Cirrhosis
Abraldes J, Caraceni P, Ghabril M, Garcia-Tsao G. Update in the Treatment of the Complications of Cirrhosis. Clinical Gastroenterology And Hepatology 2023, 21: 2100-2109. PMID: 36972759, PMCID: PMC11097249, DOI: 10.1016/j.cgh.2023.03.019.Peer-Reviewed Reviews, Practice Guidelines, Standards, and Consensus StatementsConceptsTransjugular intrahepatic portosystemic shuntVariceal hemorrhageHepatic encephalopathyPre-emptive transjugular intrahepatic portosystemic shuntsAcute variceal hemorrhageCombination of terlipressinAcute kidney injuryComplications of cirrhosisSecond-line treatmentSignificant portal hypertensionFirst-line treatmentLeast common causePrognosis of patientsOrnithine L-aspartatePresence of varicesIntrahepatic portosystemic shuntStandard of careQuality of lifeCyanoacrylate injectionHepatorenal syndromeUncomplicated ascitesKidney injuryPortal hypertensionRefractory ascitesAlbumin use
2022
Safety, Tolerability, Pharmacokinetics, and Efficacy of Terlipressin Delivered by Continuous Intravenous Infusion in Patients with Cirrhosis and Refractory Ascites
Bajaj J, Fischer J, Yeramian P, Gavis E, Fagan A, Angeli P, Garcia-Tsao G, Adams J, Markham P. Safety, Tolerability, Pharmacokinetics, and Efficacy of Terlipressin Delivered by Continuous Intravenous Infusion in Patients with Cirrhosis and Refractory Ascites. GastroHep 2022, 2022: 1-8. DOI: 10.1155/2022/5065478.Peer-Reviewed Original ResearchLarge-volume paracentesesRefractory ascitesContinuous intravenous infusionIntravenous infusionAverage steady-state plasma concentrationTreatment-related adverse eventsSteady-state plasma concentrationsML/min/Efficacy of terlipressinInfusion of terlipressinSafety/tolerabilityAdvanced liver cirrhosisPhase 2a trialVolume of ascitesVolume of distributionState plasma concentrationsHepatorenal syndromeVariceal bleedingCirrhotic patientsInpatient periodAdverse eventsLiver cirrhosisIV infusionRelated complicationsAcceptable safety
2020
SAT139 Safety, tolerability, pharmacokinetics and pharmacodynamic activity of terlipressin delivered by continuous intravenous infusion in patients with cirrhosis and refractory ascites: a phase 2a open-label trial
Bajaj J, Yeramian P, Gavis E, Fagan A, Fischer J, Garcia-Tsao G, Angeli P, Smith D, Adams J, Markham P. SAT139 Safety, tolerability, pharmacokinetics and pharmacodynamic activity of terlipressin delivered by continuous intravenous infusion in patients with cirrhosis and refractory ascites: a phase 2a open-label trial. Journal Of Hepatology 2020, 73: s718-s719. DOI: 10.1016/s0168-8278(20)31895-x.Peer-Reviewed Original Research
2019
Impact of Chronic Kidney Disease on Outcomes in Cirrhosis
Wong F, Reddy K, O’Leary J, Tandon P, Biggins SW, Garcia‐Tsao G, Maliakkal BJ, Lai JC, Fallon MB, Vargas HE, Subramanian R, Thuluvath PJ, Kamath PS, Thacker L, Bajaj JS. Impact of Chronic Kidney Disease on Outcomes in Cirrhosis. Liver Transplantation 2019, 25: 870-880. PMID: 30908855, PMCID: PMC11075743, DOI: 10.1002/lt.25454.Peer-Reviewed Original ResearchConceptsChronic kidney diseaseKidney diseasePrevalence of CKDEnd-stage liver diseaseHospital clinical courseAcute kidney injuryChild-Pugh scoreChronic liver failureHigher serum creatinineGlomerular filtration rateHigh-risk groupNorth American ConsortiumCKD groupHospital courseKidney injuryRefractory ascitesNegative patientsOverall survivalPositive patientsSerum creatinineCirrhosis etiologyClinical courseHospital admissionHospitalized patientsLiver failure
2018
Ascites
Garcia‐Tsao G. Ascites. 2018, 127-150. DOI: 10.1002/9781119237662.ch9.Peer-Reviewed Educational MaterialsLarge-volume paracentesesHepatorenal syndromeRefractory ascitesCirrhotic ascitesCommon decompensating eventMassive hepatic metastasesPlasma renin activitySecond-line treatmentFormation of ascitesDevelopment of ascitesCost-effective treatmentSinusoidal hypertensionCardiac indexRenin activityVasodilatory stateHepatic metastasesMalignant ascitesAscites formationCommon precipitantsAscitesHigh mortalityBacterial infectionsHyponatremiaMain predictorsPatients
2017
Beta‐blockers in hospitalised patients with cirrhosis and ascites: mortality and factors determining discontinuation and reinitiation
Bhutta A, Garcia‐Tsao G, Reddy K, Tandon P, Wong F, O'Leary J, Acharya C, Banerjee D, Abraldes J, Jones T, Shaw J, Deng Y, Ciarleglio M, Bajaj J. Beta‐blockers in hospitalised patients with cirrhosis and ascites: mortality and factors determining discontinuation and reinitiation. Alimentary Pharmacology & Therapeutics 2017, 47: 78-85. PMID: 28994122, PMCID: PMC6016372, DOI: 10.1111/apt.14366.Peer-Reviewed Original ResearchConceptsMean arterial pressureBeta-blocker useLower mean arterial pressureBeta-blocker discontinuationRefractory ascitesHigh mortalityLower white blood cell countBeneficial anti-inflammatory effectsWhite blood cell countAcute kidney injuryAnti-inflammatory effectsTime of discontinuationBlood cell countEffect of BBBB discontinuationKidney injuryChart reviewHospital dischargeArterial pressureDiscontinuationAscitesCirrhosisPatientsCell countMortalityChapter 36 Ascites
Garcia-Tsao G. Chapter 36 Ascites. 2017, 475-484. DOI: 10.1016/b978-0-12-804274-8.00036-9.Peer-Reviewed Educational MaterialsRefractory ascitesCommon decompensating eventNew-onset ascitesSodium-retaining systemsFirst-line therapyDevelopment of ascitesCause of deathPortal hypertensionRenal failureSodium retentionPathophysiological mechanismsOvert infectionAscitesPathogenic cascadeHigh mortalityVasodilatationEarly placementPatientsCirrhosisDeathHypertensionTherapyInfectionMortality
2016
Approach to the Patient with Ascites and Its Complications
Garcia‐Tsao G. Approach to the Patient with Ascites and Its Complications. 2016, 447-458. DOI: 10.1002/9781118512104.ch55.Peer-Reviewed Reviews, Practice Guidelines, Standards, and Consensus StatementsLarge-volume paracentesisSpontaneous bacterial peritonitisNew-onset ascitesPresence of ascitesAcute renal failureFirst-line therapyMainstay of therapySerial large-volume paracentesisEtiology of ascitesAccumulation of fluidHepatorenal syndromePeritoneal malignancyAbdominal ultrasonographyRefractory ascitesSodium restrictionHepatic hydrothoraxLine therapyRenal failureBacterial peritonitisHeart failureDecompensated stageCirrhotic ascitesCommon causePeritoneal cavityAscitesImpact of Treatment of Non-bleeding Complications of Cirrhosis on the Risk of Variceal Bleeding
Augustin S, Albillos A, Ripoll C, Abraldes J, Salerno F, Moreau R, Reiberger T, Garcia-Tsao G. Impact of Treatment of Non-bleeding Complications of Cirrhosis on the Risk of Variceal Bleeding. 2016, 341-353. DOI: 10.1007/978-3-319-23018-4_34.Peer-Reviewed Original ResearchHepatic venous pressure gradientVariceal hemorrhageVariceal bleedingPortal pressureAlpha-1 adrenergic antagonistNon-bleeding complicationsVenous pressure gradientPortal blood flowClinical trial recordsImpact of treatmentDecompensated cirrhosisOral anticoagulantsRefractory ascitesCirrhotic patientsClinical decompensationCohort studyArterial pressureVasoactive drugsRandomized trialsLarge trialsCardiac outputProphylactic useAdrenergic antagonistsClinical dataBlood flowSecondary Prophylaxis in Special Patient Populations
Reiberger T, Moreau R, Ripoll C, Albillos A, Augustin S, Salerno F, Abraldes J, Garcia-Tsao G. Secondary Prophylaxis in Special Patient Populations. 2016, 317-332. DOI: 10.1007/978-3-319-23018-4_32.Peer-Reviewed Reviews, Practice Guidelines, Standards, and Consensus StatementsSecondary prophylaxisRefractory ascitesVariceal bleedingSurvival benefitClinical nonrespondersClear precipitating eventProphylaxis of varicealBeta-blocker therapyBeta-blocker treatmentEndoscopic band ligationSpecial patient populationsAdvanced cirrhosisNSBB therapyVariceal rebleedingArterial hypotensionCirrhotic patientsFurther decompensationSerum creatinineBand ligationPatient populationProphylaxisHigh riskCurrent evidencePatientsAscites
2015
Natural History of Cirrhosis
Garcia-Tsao G. Natural History of Cirrhosis. 2015, 13-20. DOI: 10.1007/978-3-319-13614-1_2.Peer-Reviewed Reviews, Practice Guidelines, Standards, and Consensus StatementsPrognostic stageHepatic venous pressure gradientNatural historyDifferent prognostic stagesRecurrent variceal hemorrhageVenous pressure gradientMulti-organ failureAbsence of varicesHepatorenal syndromeDecompensated cirrhosisRefractory ascitesVariceal hemorrhageHepatic encephalopathyLiver failureSpecific complicationsWorse prognosisDecompensated stageReversible diseaseCirrhosisPatientsVaricesPrognosisDecompensationAscitesComplications
2012
The Combination of Octreotide and Midodrine Is Not Superior to Albumin in Preventing Recurrence of Ascites After Large-Volume Paracentesis
Bari K, Miñano C, Shea M, Inayat IB, Hashem HJ, Gilles H, Heuman D, Garcia–Tsao G. The Combination of Octreotide and Midodrine Is Not Superior to Albumin in Preventing Recurrence of Ascites After Large-Volume Paracentesis. Clinical Gastroenterology And Hepatology 2012, 10: 1169-1175. PMID: 22801062, PMCID: PMC3678262, DOI: 10.1016/j.cgh.2012.06.027.Peer-Reviewed Original ResearchConceptsPostparacentesis circulatory dysfunctionRecurrence of ascitesVasoconstrictor groupAlbumin groupRefractory ascitesAscites recurrenceCombination of midodrineCombination of octreotidePlacebo-controlled trialLarge-volume paracentesisEffective blood volumeTreatment of choiceSingle intravenous doseOral midodrinePreventing RecurrenceRenal failureCirculatory dysfunctionMedian timeSerum levelsIntravenous doseIntramuscular injectionIntravenous administrationAscitesMidodrineBlood volume
2011
Ascites
Garcia‐Tsao G. Ascites. 2011, 210-233. DOI: 10.1002/9781444341294.ch10.Peer-Reviewed Reviews, Practice Guidelines, Standards, and Consensus StatementsHepatorenal syndromeBacterial infectionsBaseline renal dysfunctionPeripheral arterial vasodilatationAcute kidney injurySecond-line treatmentMainstay of treatmentSpontaneous bacterial peritonitisSympathetic nervous systemEffective blood volumeSpontaneous bacterial infectionsCommon bacterial infectionsSigns of infectionLong-term safetyDiagnostic paracentesisIntravenous albuminPrerenal typeSinusoidal hypertensionAldosterone systemArterial vasodilatationKidney injuryLiver transplantationRefractory ascitesRenal dysfunctionSodium restriction
2010
Refractory ascites: pathogenesis, definition and therapy of a severe complication in patients with cirrhosis
Salerno F, Guevara M, Bernardi M, Moreau R, Wong F, Angeli P, Garcia‐Tsao G, Lee SS. Refractory ascites: pathogenesis, definition and therapy of a severe complication in patients with cirrhosis. Liver International 2010, 30: 937-947. PMID: 20492521, DOI: 10.1111/j.1478-3231.2010.02272.x.Peer-Reviewed Reviews, Practice Guidelines, Standards, and Consensus StatementsConceptsCirrhotic patientsHepatorenal syndrome type 2Transjugular intrahepatic portosystemic shuntEpisode of ascitesChronic renal insufficiencyLow sodium dietStandard medical treatmentIntrahepatic portosystemic shuntOccurrence of refractorinessCentral hypovolaemiaVasoconstrictor systemsArterial hypotensionDiuretic dosesLiver transplantationPortal hypertensionRefractory ascitesRenal insufficiencySodium dietSystemic haemodynamicsFrequent complicationSevere complicationsSerious complicationsSuch patientsPortosystemic shuntRenal sodium
2006
Portal hypertension
Garcia-Tsao G. Portal hypertension. Current Opinion In Internal Medicine 2006, 5: 399-407. DOI: 10.1097/01.mog.0000218962.93806.9a.Peer-Reviewed Reviews, Practice Guidelines, Standards, and Consensus StatementsPortal hypertensionVariceal bleedingTransjugular intrahepatic portosystemic shuntRecurrent variceal bleedingLarge-volume paracentesisSpontaneous bacterial peritonitisEndoscopic variceal ligationIntrahepatic portosystemic shuntHepatorenal syndromeRefractory ascitesBacterial peritonitisVariceal ligationSpecific complicationsPortosystemic shuntHypertensionΒ-blockersComplicationsTrialsBleedingVaricesAscitesDiagnosisRecent findingsRecent studiesCirrhosis
2005
Transjugular Intrahepatic Portosystemic Shunt (Tips) for the Management of Refractory Ascites in Cirrhosis
Garcia‐Tsao G. Transjugular Intrahepatic Portosystemic Shunt (Tips) for the Management of Refractory Ascites in Cirrhosis. 2005, 251-259. DOI: 10.1002/9780470987476.ch20.Peer-Reviewed Reviews, Practice Guidelines, Standards, and Consensus Statements
2003
The management of ascites in cirrhosis: Report on the consensus conference of the international Ascites club
Moore K, Wong F, Gines P, Bernardi M, Ochs A, Salerno F, Angeli P, Porayko M, Moreau R, Garcia‐Tsao G, Jimenez W, Planas R, Arroyo V. The management of ascites in cirrhosis: Report on the consensus conference of the international Ascites club. Hepatology 2003, 38: 258-266. PMID: 12830009, DOI: 10.1053/jhep.2003.50315.Peer-Reviewed Original ResearchConceptsTransjugular intrahepatic portosystemic stent shuntInternational Ascites ClubDiuretic therapyRefractory ascitesColloid volume expansionModest salt restrictionLarge-volume paracentesisManagement of ascitesDevelopment of ascitesHepatic decompensationModerate ascitesGross ascitesLiver transplantationRenal dysfunctionSalt restrictionSodium excretionSodium restrictionTherapeutic paracentesisRenal functionSurvival benefitCommon complicationLiver diseasePancreatic ascitesAscitic patientsTIPS placement
2002
Transjugular intrahepatic portosystemic shunting versus paracentesis plus albumin for refractory ascites in cirrhosis
Ginès P, Uriz J, Calahorra B, Garcia–Tsao G, Kamath PS, Del Arbol LR, Planas R, Bosch J, Arroyo V, Rodés J, Cirrhosis F. Transjugular intrahepatic portosystemic shunting versus paracentesis plus albumin for refractory ascites in cirrhosis. Gastroenterology 2002, 123: 1839-1847. PMID: 12454841, DOI: 10.1053/gast.2002.37073.Peer-Reviewed Original ResearchMeSH KeywordsAscitesBacterial InfectionsFemaleGastrointestinal HemorrhageHepatic EncephalopathyHormonesHumansInjections, IntravenousKidneyLiverLiver CirrhosisMaleMiddle AgedParacentesisPeritonitisPortasystemic Shunt, Transjugular IntrahepaticRetreatmentSerum AlbuminSeverity of Illness IndexSurvival AnalysisConceptsTransjugular intrahepatic portosystemic shuntRefractory ascitesParacentesis groupLiver transplantationHepatorenal syndromeTIPS groupTransjugular intrahepatic portosystemic shuntingBlood urea nitrogen levelsChild-Pugh scoreComplications of cirrhosisIntrahepatic portosystemic shuntRecurrence of ascitesSevere hepatic encephalopathyUrea nitrogen levelsIntravenous albuminPrimary endpointSecondary endpointsHepatic encephalopathyPortosystemic shuntingPortosystemic shuntAscites recurrenceParacentesisHealthcare costsAscitesProbability of survival