An evidence-based approach to studies in cirrhosis and portal hypertension: medical management of mild to moderate ascites

Previous articles in this series have examined the critical appraisal of isolated structured clinical questions using the framework of evidence-based medicine. When patients are identified with a disease-specific process, however, an integrated approach for addressing multiple questions is required. This article, the sixth in the evidence-based medicine series for this journal, integrates critical appraisal techniques to examine the decision-making process used when evaluating a patient with cirrhosis and new-onset mild to moderate ascites. In the following clinical scenario, an approach is described for determining prognosis after the development of ascites and whether salt restriction and oral diuretics are effective therapies. The format is similar to other evidence-based medicine articles published in the Journal of the American Medical Association. The evidence-based medicine concepts have been expanded from previous articles, and examples from the hepatology literature have been used.