From the Research
Patients with chylous ascites typically need to follow a low-fat diet supplemented with medium-chain triglycerides (MCTs) for at least 2 weeks, and in some cases, up to several months, as evidenced by the most recent study 1. The initial treatment period should be at least 2 weeks, with dietary therapy continuing until clinical improvement is observed. This dietary approach works because MCTs are directly absorbed into the portal circulation, bypassing the lymphatic system, thereby reducing chyle production and accumulation in the peritoneal cavity. Some key points to consider when implementing this diet include:
- Restricting long-chain triglycerides to less than 10 grams per day
- Providing adequate protein and calories through MCT oil supplements (typically 15-20 mL with meals)
- Monitoring patients for resolution of ascites through physical examination and, if necessary, follow-up paracentesis to assess triglyceride levels in the ascitic fluid
- Considering additional interventions such as somatostatin analogs, paracentesis, or surgical intervention if symptoms persist despite dietary management
- Closely monitoring nutritional status during treatment to prevent deficiencies in essential fatty acids and fat-soluble vitamins, as noted in various studies 2, 3, 4, 5. It's also important to note that orlistat, a fat absorption inhibitor, has shown potential efficacy in treating chylous ascites, particularly in patients who are unable to comply with dietary restrictions, as reported in a recent case study 1.