Our Focus: Ascites
Overview
Development of ascites, excess fluid in the peritoneal cavity, is the most common complication of decompensated cirrhosis and is considered a feature of the progression of cirrhosis to decompensated cirrhosis. The increased portal hypertension associated with decompensated cirrhosis causes lymphatic fluid to leak out across hepatic vasculature and pool in large volumes in the peritoneal cavity. Initial treatments include dietary modifications and diuretics; however, a significant number of patients progress in their disease and no longer respond to these interventions. With progression, both quality of life and prognosis severely diminish. Ascites that is not well managed can lead to renal complications, hernias, and difficulty in eating, drinking, breathing and moving due to the abdominal distention. Survival rates at this disease stage can be as low as 50% at 6-12 months post-diagnosis.
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Prevalence
Approximately 500,000 patients in the United States at any given time suffer from decompensated cirrhosis and approximately two-thirds of all those patients will develop ascites. Data suggests that greater than 10 percent of the ascites patients will go on to develop ascites that is not well managed by dietary modifications, diuretics or albumin infusion. Those patients require much more aggressive treatment approaches, and many will experience a significant increase in hospital admissions.
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Treatment
As first-line treatment approaches to ascites are determined to not be sufficient in managing an individual’s condition, considerably more invasive measures are used to eliminate the fluid. These include direct aspiration of the ascites (paracentesis), placement of a low flow ascites pump or a shunt that diverts the blood away from the congested portal veins (transjugular intrahepatic portosystemic shunt [TIPS]). Each of these approaches comes with significant risks such as infection, circulatory dysfunction or hepatic encephalopathy. OCE-205, with its unique mechanism of action, offers the promise of a non-invasive, therapeutic solution.
Sources:
1. Gastroenterol Hepatol (N Y). 2009 Sep; 5(9): 647–656.
2. Wong F. Management of Refractory Ascites. Clin Mol Hepatol. 2022 Jun 9. doi: 10.3350/cmh.2022.0104
3. Planas, Ramon, et al. “Natural History of Patients Hospitalized for Management of Cirrhotic Ascites.” Clinical Gastroenterology and Hepatology, vol. 4, no. 11, 2006, https://doi.org/10.1016/j.cgh.2006.08.007.
4. Fagan KJ, Zhao EY, Horsfall LU, et al. Burden of decompensated cirrhosis and ascites on hospital services in a tertiary care facility: time for change? Intern Med J. 2014 Sep;44(9):865-72. doi: 10.1111/imj.12491. PMID: 24893971.
Ascites Impact on Abdomen
