A pilot project by a team of doctors from hepatology department, Post Graduate Institute, Chandigarh found that midodrine and a combination of midodrine and tolvaptan plus standard medical therapy helped in controlling ascites and prevented damage of kidneys in cirrhosis. The development of ascites in the natural history of cirrhosis indicates a worsening of the prognosis to 50% survival at 2 years, and this deteriorates to 30-50% at 1 year when the ascites becomes refractory to medical therapy. Hemodynamic alterations and their relation to neurohumoral systems are essential in the pathophysiology of ascites formation.
The therapeutic options available for patients with refractory ascites are serial therapeutic paracentesis, liver transplantation, and transjugular intrahepatic portosystemic shunts, but those are invasive, costly and involves risk. Other medications include vasopressin…
