Beyond conventional treatments: cutting-edge strategies for ascites in cirrhosis

Ascites is a prevalent complication in cases of decompensated liver cirrhosis, having a considerable effect on the quality of life and prognosis of patients. Current treatment methods of ascites in cirrhosis primarily include conventional diuretics, paracentesis, albumin infusion, transjugular intrahepatic portosystemic shunt (TIPS), and liver transplantation. However, these approaches are associated with certain limitations and risks. In recent years, novel therapeutic strategies targeting distinct pathophysiological pathways of ascites have continued to emerge, including sodium-glucose cotransporter 2 (SGLT2) inhibitors, vasopressin analogues, regenerative medicine, and gut microbiota modulation. The present review focuses on emerging pharmacological strategies for ascites in cirrhosis, systematically summarizes their mechanisms of action, and discusses their efficacy, safety, and limitations, while also outlining future research directions.