Comparison between theophylline and spironolactone in the management of cirrhotic ascites: a randomized controlled study

Background: It has been suggested that adenosine is involved in the renal haemodynamic and tubular abnormalities observed in cirrhosis. Low-dose theophylline is an adenosine antagonist: and recent studies have shown that this drug can improve renal blood flow and sodium excretion in cirrhotic patients. Methods: Fifteen patients with newly diagnosed cirrhotic ascites were randomized to receive either 100 mg spironolactone daily for 7 days or 250 mg theophylline on days 1, 2, 4 and 6. Baseline clinical and urinary and serum biochemical data were collected and compared following therapy. Results: After 7 days of spironolactone there were increases in urinary sodium excretion (43.5 ± 15.6 vs. 106.8 ± 34.7 mmol/day; P < 0.05) and urine volume (769.1 ± 206.5 vs 1541.6 ± 342.6 mL/day; P < 0.05). No changes in the patients' weight, creatinine clearance or serum electrolytes were observed. No change was detected in any of these parameters following theophylline therapy. Conclusion: Adenosine antagonism in the form of low-dose theophylline is less efficacious than spironolactone in the management of cirrhotic ascites

Efficacy of balloon angioplasty, restenting, and parallel shunt insertion for shunt insuffiency after transjugular intrahepatic portosystemic stent-shunt (TIPSS)

Our aim was to assess the efficacy of balloon angioplasty, restenting and parallel shunt insertion in maintaining the patency of transjugular intrahepatic portosystemic stent-shunts (TIPSS). From July 1991 to July 1997 TIPSS was successfully performed in 223 patients. Shunt patency was assessed by direct transjugular portography at 4 months, then 6 monthly, or whenever complications occurred. 101 patients developed shunt insufficiency, requiring intervention. 45 patients had their initial shunt restented and 34 of them went on to have further balloon angioplasty of their shunt. 61 patients were managed by balloon angioplasty of the shunt alone and 53 of them still have a patent shunt. 29 patients had a parallel shunt inserted and 16 still have a patent parallel shunt at the end of the follow-up period. Primary shunt patency was 58% in 1 year and 32% over 2 years. Over a total population of 223 patients who underwent TIPSS insertion, in 202 (90.6%) secondary patency is maintained. The combination of balloon angioplasty, restenting and parallel shunt insertion was effective in maintaining shunt patency in the vast majority of patients who underwent TIPSS insertion. Regular shunt surveillance is required