2023
AGA Clinical Practice Update on the Use of Vasoactive Drugs and Intravenous Albumin in Cirrhosis: Expert Review
Garcia-Tsao G, Abraldes J, Rich N, Wong V. AGA Clinical Practice Update on the Use of Vasoactive Drugs and Intravenous Albumin in Cirrhosis: Expert Review. Gastroenterology 2023, 166: 202-210. PMID: 37978969, DOI: 10.1053/j.gastro.2023.10.016.Peer-Reviewed Original ResearchConceptsSpontaneous bacterial peritonitisAcute kidney injuryLarge-volume paracentesisEffective arterial blood volumeVasoactive drugsVariceal hemorrhageArterial blood volumeHRS-AKIUncomplicated ascitesIntravenous albuminVolume statusPractice UpdateBlood volumeChronic liver failure grade 3Best practice advice statementsClinical Practice Updates CommitteeEnd-stage liver diseaseAGA Clinical Practice UpdateForms of AKIIntensive care unit monitoringAGA Governing BoardCombination of vasoconstrictorsInitial endoscopic hemostasisPatient's volume statusClinical Practice UpdateUpdate 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
Role of Oral Health, Frailty, and Minimal Hepatic Encephalopathy in the Risk of Hospitalization: A Prospective Multi-Center Cohort of Outpatients With Cirrhosis
Bajaj J, Lai J, Tandon P, O'Leary J, Wong F, Garcia-Tsao G, Vargas H, Kamath P, Biggins S, Limon-Miro A, Shaw J, Mbachi C, Chew M, Golob Deeb J, Thacker L, Reddy K. Role of Oral Health, Frailty, and Minimal Hepatic Encephalopathy in the Risk of Hospitalization: A Prospective Multi-Center Cohort of Outpatients With Cirrhosis. Clinical Gastroenterology And Hepatology 2022, 21: 1864-1872.e2. PMID: 36328307, PMCID: PMC11057906, DOI: 10.1016/j.cgh.2022.10.023.Peer-Reviewed Original ResearchConceptsPoor oral healthOral healthMulti-center cohortCirrhosis detailsComorbid conditionsLiver diseaseEnd-stage liver diseaseMulti-center cohort studyRisk of hospitalizationPortal hypertensive complicationsMinimal hepatic encephalopathyNew study cohortMulti-variable analysisCirrhosis complicationsNonelective hospitalizationPeriodontitis historyPrior HEFrailty assessmentFrailty scoreHypertensive complicationsCohort studyHepatic encephalopathyStudy cohortRisk factorsCirrhosis
2021
Diagnosis, Evaluation, and Management of Ascites, Spontaneous Bacterial Peritonitis and Hepatorenal Syndrome: 2021 Practice Guidance by the American Association for the Study of Liver Diseases
Biggins SW, Angeli P, Garcia‐Tsao G, Ginès P, Ling SC, Nadim MK, Wong F, Kim WR. Diagnosis, Evaluation, and Management of Ascites, Spontaneous Bacterial Peritonitis and Hepatorenal Syndrome: 2021 Practice Guidance by the American Association for the Study of Liver Diseases. Hepatology 2021, 74: 1014-1048. PMID: 33942342, DOI: 10.1002/hep.31884.Peer-Reviewed Reviews, Practice Guidelines, Standards, and Consensus Statements
2020
Sodium‐Glucose Cotransporter 2 Inhibitors Ameliorate Ascites and Peripheral Edema in Patients With Cirrhosis and Diabetes
Montalvo‐Gordon I, Chi‐Cervera L, García‐Tsao G. Sodium‐Glucose Cotransporter 2 Inhibitors Ameliorate Ascites and Peripheral Edema in Patients With Cirrhosis and Diabetes. Hepatology 2020, 72: 1880-1882. PMID: 32294260, DOI: 10.1002/hep.31270.Peer-Reviewed Original Research
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 countMortality
2016
Beta-blockers in patients with cirrhosis and ascites: type of beta-blocker matters
Njei B, McCarty TR, Garcia-Tsao G. Beta-blockers in patients with cirrhosis and ascites: type of beta-blocker matters. Gut 2016, 65: 1393. PMID: 27207973, DOI: 10.1136/gutjnl-2016-312129.Peer-Reviewed Original Research
2014
Serum B‐type natriuretic peptide in the initial workup of patients with new onset ascites: A diagnostic accuracy study
Farias AQ, Silvestre OM, Garcia‐Tsao G, da Costa Seguro L, de Campos Mazo D, Bacal F, Andrade JL, Gonçalves LL, Strunz C, Ramos DS, Polli D, Pugliese V, Rodrigues AC, Furtado MS, Carrilho FJ, D'Albuquerque LA. Serum B‐type natriuretic peptide in the initial workup of patients with new onset ascites: A diagnostic accuracy study. Hepatology 2014, 59: 1043-1051. PMID: 23907731, DOI: 10.1002/hep.26643.Peer-Reviewed Original ResearchConceptsSerum B-type natriuretic peptideB-type natriuretic peptideSerum-ascites albumin gradientNew-onset ascitesDiagnosis of HFHeart failureCause of ascitesConsecutive patientsNatriuretic peptideTotal protein concentrationResult of HFHighest positive likelihood ratioLow negative likelihood ratioWorkup of patientsCross-sectional studyPg/mLPositive likelihood ratioDiagnostic accuracy studiesNegative likelihood ratioDiagnostic paracentesisPeritoneal diseaseInitial workupLikelihood ratioConstrictive pericarditisValidation cohort
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 volumePrognostic indicators of survival in patients with compensated and decompensated cirrhosis
Zipprich A, Garcia‐Tsao G, Rogowski S, Fleig WE, Seufferlein T, Dollinger MM. Prognostic indicators of survival in patients with compensated and decompensated cirrhosis. Liver International 2012, 32: 1407-1414. PMID: 22679906, PMCID: PMC3713489, DOI: 10.1111/j.1478-3231.2012.02830.x.Peer-Reviewed Original ResearchConceptsHepatic venous pressure gradientPredictors of deathCompensated patientsPortal hypertensionPrognostic valueComplications of cirrhosisSignificant portal hypertensionStage 2 patientsVenous pressure gradientDecompensated patientsSystemic haemodynamicsVariceal hemorrhagePortal pressureIndependent predictorsMultivariable analysisClinical eventsDecompensated stagePrognostic indicatorStaging systemLonger survivalBACKGROUND/CirrhosisPatientsSurvival rateAnalyse survival
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
2007
Hepatic Venous Pressure Gradient Predicts Clinical Decompensation in Patients With Compensated Cirrhosis
Ripoll C, Groszmann R, Garcia–Tsao G, Grace N, Burroughs A, Planas R, Escorsell A, Garcia–Pagan J, Makuch R, Patch D, Matloff DS, Bosch J, Group P. Hepatic Venous Pressure Gradient Predicts Clinical Decompensation in Patients With Compensated Cirrhosis. Gastroenterology 2007, 133: 481-488. PMID: 17681169, DOI: 10.1053/j.gastro.2007.05.024.Peer-Reviewed Original ResearchMeSH KeywordsAgedAscitesEsophageal and Gastric VaricesFemaleFollow-Up StudiesGastrointestinal HemorrhageHepatic EncephalopathyHumansHypertension, PortalKaplan-Meier EstimateLiver CirrhosisMaleMiddle AgedPortal PressurePredictive Value of TestsPrognosisProportional Hazards ModelsProspective StudiesRisk AssessmentRisk FactorsROC CurveSensitivity and SpecificitySeverity of Illness IndexTime FactorsConceptsHepatic venous pressure gradientVenous pressure gradientClinical decompensationPortal hypertensionMedian hepatic venous pressure gradientEnd-stage liver diseaseDiagnostic capacityBaseline laboratory testsPredictors of decompensationChild-Pugh scoreDevelopment of varicesMedical record reviewEnd of studyMedian followCompensated cirrhosisLiver transplantationLiver diseaseRecord reviewStudy terminationDecompensationPatientsCirrhosisMultivariate analysisVaricesHypertension
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
2001
CLINICAL MANAGEMENT OF ASCITES AND ITS COMPLICATIONS
Wongcharatrawee S, Garcia-Tsao G. CLINICAL MANAGEMENT OF ASCITES AND ITS COMPLICATIONS. Clinics In Liver Disease 2001, 5: 833-850. PMID: 11565143, DOI: 10.1016/s1089-3261(05)70194-x.Peer-Reviewed Reviews, Practice Guidelines, Standards, and Consensus StatementsConceptsEffective arterial blood volumeElimination of ascitesTherapy of ascitesPoor prognostic signYear mortality rateDevelopment of ascitesArterial blood volumeQuality of lifeSinusoidal hypertensionLiver transplantationCirrhotic patientsSurvival benefitLethal complicationPathophysiologic abnormalitiesPrognostic signSodium retentionCurrent therapiesAscites formationClinical managementAscitesBlood volumeMortality rateComplicationsTherapyHypertensionTreatment of refractory ascites: Tips or taps?
Garcia‐Tsao G. Treatment of refractory ascites: Tips or taps? Hepatology 2001, 33: 477-479. PMID: 11172354, DOI: 10.1053/jhep.2001.0330477.Commentaries, Editorials and LettersCurrent management of the complications of cirrhosis and portal hypertension: Variceal hemorrhage, ascites, and spontaneous bacterial peritonitis
Garcia–Tsao G. Current management of the complications of cirrhosis and portal hypertension: Variceal hemorrhage, ascites, and spontaneous bacterial peritonitis. Gastroenterology 2001, 120: 726-748. PMID: 11179247, DOI: 10.1053/gast.2001.22580.Peer-Reviewed Reviews, Practice Guidelines, Standards, and Consensus Statements
2000
Diagnosis, treatment and prophylaxis of spontaneous bacterial peritonitis: a consensus document
Rimola A, García-Tsao G, Navasa M, Piddock L, Planas R, Bernard B, Inadomi J, Club T. Diagnosis, treatment and prophylaxis of spontaneous bacterial peritonitis: a consensus document. Journal Of Hepatology 2000, 32: 142-153. PMID: 10673079, DOI: 10.1016/s0168-8278(00)80201-9.Peer-Reviewed Reviews, Practice Guidelines, Standards, and Consensus Statements
1998
The diagnostic and predictive value of ascites nitric oxide levels in patients with spontaneous bacterial peritonitis
Garcia‐Tsao G, Angulo P, Garcia J, Groszmann R, Cadelina G. The diagnostic and predictive value of ascites nitric oxide levels in patients with spontaneous bacterial peritonitis. Hepatology 1998, 28: 17-21. PMID: 9657091, DOI: 10.1002/hep.510280104.Peer-Reviewed Original ResearchConceptsSpontaneous bacterial peritonitisCirrhotic patientsNO levelsSterile ascitesBacterial peritonitisDiagnosis of SBPNitric oxideBaseline NO levelsSerum NO levelsCulture-negative peritonitisSevere liver diseaseNitric oxide metabolitesUseful prognostic markerNitric oxide levelsSignificant direct correlationInitial paracentesisLiver diseaseSerum levelsOxide metabolitesPrognostic markerOxide levelsPeritonitisAscitesAscites samplesPatients
1995
Bacterial translocation to mesenteric lymph nodes is increased in cirrhotic rats with ascites
Garcia-Tsao G, Lee F, Barden G, Cartun R, West A. Bacterial translocation to mesenteric lymph nodes is increased in cirrhotic rats with ascites. Gastroenterology 1995, 108: 1835-1841. PMID: 7768390, DOI: 10.1016/0016-5085(95)90147-7.Peer-Reviewed Original ResearchConceptsMesenteric lymph nodesLymph nodesBacterial translocationCirrhotic ratsPositive mesenteric lymphRegional lymph nodesDevelopment of ascitesE. coli translocationStandard bacteriologic cultureCCl4 inhalationSpontaneous bacteremiaCirrhotic patientsMesenteric lymphSubmucosal edemaPassage of bacteriaRat modelBACKGROUND/Systemic circulationAscitesCecal wallNormal controlsIntestinal lumenCirrhosisSpontaneous infectionBacteriologic culture