Skip to main content
Erschienen in: Metabolic Brain Disease 3-4/2007

01.12.2007 | ORIGINAL PAPER

The treatment of hepatic encephalopathy

verfasst von: Marsha Y. Morgan, A. Blei, K. Grüngreiff, R. Jalan, G. Kircheis, G. Marchesini, O. Riggio, Karin Weissenborn

Erschienen in: Metabolic Brain Disease | Ausgabe 3-4/2007

Einloggen, um Zugang zu erhalten

Abstract

Current recommendations for the treatment of hepatic encephalopathy are based, to a large extent, on open or uncontrolled trials, undertaken in very small numbers of patients. In consequence, there is ongoing discussion as to whether the classical approach to the treatment of this condition, which aims at reducing ammonia production and absorption using either non-absorbable disaccharides and/or antibiotics, should be revisited, modified or even abandoned. Pros and cons of present therapeutic strategies and possible future developments were discussed at the fourth International Hannover Conference on Hepatic Encephalopathy held in Dresden in June 2006. The content of this discussion is summarized.
Literatur
Zurück zum Zitat Als-Nielsen B, Gluud LL, Gluud C (2004a) Non-absorbable disaccharides for hepatic encephalopathy: systematic review of randomized trials. BMJ 328:1046–1051PubMedCrossRef Als-Nielsen B, Gluud LL, Gluud C (2004a) Non-absorbable disaccharides for hepatic encephalopathy: systematic review of randomized trials. BMJ 328:1046–1051PubMedCrossRef
Zurück zum Zitat Als-Nielsen B, Gluud LL, Gluud C (2004b) Non-absorbable disaccharides for hepatic encephalopathy (Cochrane review). In: The Cochrane Library, Issue 2. Wiley, Chichester, UK Als-Nielsen B, Gluud LL, Gluud C (2004b) Non-absorbable disaccharides for hepatic encephalopathy (Cochrane review). In: The Cochrane Library, Issue 2. Wiley, Chichester, UK
Zurück zum Zitat Als-Nielsen B, Koretz RL, Kjaergard LL, Gluud C (2004c) Branched-chain amino acids for hepatic encephalopathy (Cochrane review). In: The Cochrane Library, Issue 2. Wiley, Chichester, UK Als-Nielsen B, Koretz RL, Kjaergard LL, Gluud C (2004c) Branched-chain amino acids for hepatic encephalopathy (Cochrane review). In: The Cochrane Library, Issue 2. Wiley, Chichester, UK
Zurück zum Zitat Bass NM (2006) The current pharmacological therapies for hepatic encephalopathy. Aliment Pharmacol Ther 25(1):23–31 Bass NM (2006) The current pharmacological therapies for hepatic encephalopathy. Aliment Pharmacol Ther 25(1):23–31
Zurück zum Zitat Bircher J, Müller J, Guggenheim P, Hammerli UP (1966) Treatment of chronic portal systemic encephalopathy with lactulose. Lancet i:890–892 Bircher J, Müller J, Guggenheim P, Hammerli UP (1966) Treatment of chronic portal systemic encephalopathy with lactulose. Lancet i:890–892
Zurück zum Zitat Blanc P, Daures JP, Liautard J, Buttigieg R, Desprez D, Pageaux G et al (1994) Lactulose–neomycin combination versus placebo in the treatment of acute hepatic encephalopathy. Results of a randomized controlled trial. Gastroenterol Clin Biol 18:1063–1068PubMed Blanc P, Daures JP, Liautard J, Buttigieg R, Desprez D, Pageaux G et al (1994) Lactulose–neomycin combination versus placebo in the treatment of acute hepatic encephalopathy. Results of a randomized controlled trial. Gastroenterol Clin Biol 18:1063–1068PubMed
Zurück zum Zitat Blei AT (2004) Infection, inflammation and hepatic encephalopathy, synergism redefined. J Hepatol 40:327–330PubMedCrossRef Blei AT (2004) Infection, inflammation and hepatic encephalopathy, synergism redefined. J Hepatol 40:327–330PubMedCrossRef
Zurück zum Zitat Canales JJ, Elayadi A, Errami M, Llansola M, Cauli O, Felipo V (2003) Chronic hyperammonemia alters motor and neurochemical responses to activation of group I metabotropic glutamate receptors in the nucleus accumbens in rats in vivo. Neurobiol Dis 14:380–390PubMedCrossRef Canales JJ, Elayadi A, Errami M, Llansola M, Cauli O, Felipo V (2003) Chronic hyperammonemia alters motor and neurochemical responses to activation of group I metabotropic glutamate receptors in the nucleus accumbens in rats in vivo. Neurobiol Dis 14:380–390PubMedCrossRef
Zurück zum Zitat Chandra RK, McBean LD (1994) Zinc and immunity. Nutrition 10:79–80PubMed Chandra RK, McBean LD (1994) Zinc and immunity. Nutrition 10:79–80PubMed
Zurück zum Zitat Conn HO, Lieberthal MM (1979) The hepatic coma syndromes and lactulose. Williams and Wilkins, Baltimore Conn HO, Lieberthal MM (1979) The hepatic coma syndromes and lactulose. Williams and Wilkins, Baltimore
Zurück zum Zitat Córdoba J, Mínguez B, Vergara M (2005) Treatment of hepatic encephalopathy. Lancet 365:1384–1385PubMedCrossRef Córdoba J, Mínguez B, Vergara M (2005) Treatment of hepatic encephalopathy. Lancet 365:1384–1385PubMedCrossRef
Zurück zum Zitat Dejong C, Deutz N, Soeters P (1993) Renal ammonia and glutamine metabolism during liver insufficiency-induced hyperammonemia in the rat. J Clin Invest 92:2834–2840PubMedCrossRef Dejong C, Deutz N, Soeters P (1993) Renal ammonia and glutamine metabolism during liver insufficiency-induced hyperammonemia in the rat. J Clin Invest 92:2834–2840PubMedCrossRef
Zurück zum Zitat Dragon Y, Avraham Y, Ilan Y, Mechoulam R, Berry EM (2007) Cannabinoids ameliorate cerebral dysfunction following liver failure via AMP-activated protein kinase. FASEB J (in press) Dragon Y, Avraham Y, Ilan Y, Mechoulam R, Berry EM (2007) Cannabinoids ameliorate cerebral dysfunction following liver failure via AMP-activated protein kinase. FASEB J (in press)
Zurück zum Zitat Erceg S, Monfort P, Hernandez-Viadel M, Rodrigo R, Montoliu C, Felipo V (2005) Oral administration of sidenafil restore learning ability in rats with hyperammonemia and with portacaval shunts. Hepatology 41:299–306PubMedCrossRef Erceg S, Monfort P, Hernandez-Viadel M, Rodrigo R, Montoliu C, Felipo V (2005) Oral administration of sidenafil restore learning ability in rats with hyperammonemia and with portacaval shunts. Hepatology 41:299–306PubMedCrossRef
Zurück zum Zitat Fleig WE, Kircheis G, Spengler U, Zeuzem St, Görtelmeyer R, German–Austrian–Swiss Multicentre Study Group (1999) Placebo-controlled, double-blind evaluation of l-ornithine–l-aspartate (LOLA) granules in patients with cirrhosis and subclinical (SHE) or mild overt hepatic encephalopathy (HE). J Hepatol 30(1):65CrossRef Fleig WE, Kircheis G, Spengler U, Zeuzem St, Görtelmeyer R, German–Austrian–Swiss Multicentre Study Group (1999) Placebo-controlled, double-blind evaluation of l-ornithine–l-aspartate (LOLA) granules in patients with cirrhosis and subclinical (SHE) or mild overt hepatic encephalopathy (HE). J Hepatol 30(1):65CrossRef
Zurück zum Zitat Grüngreiff K, Presser HJ, Franke D, Lössner B, Abicht K, Kleine FD (1989) Correlations between zinc, amino acids and ammonia in liver cirrhosis. Z Gastroenterol 27:731–735PubMed Grüngreiff K, Presser HJ, Franke D, Lössner B, Abicht K, Kleine FD (1989) Correlations between zinc, amino acids and ammonia in liver cirrhosis. Z Gastroenterol 27:731–735PubMed
Zurück zum Zitat Grüngreiff K, Grüngreiff S, Reinhold D (2000) Zinc deficiency and hepatic encephalopathy. Results of a long-term zinc supplementation. Trace Elem Exp Med 13:21–31CrossRef Grüngreiff K, Grüngreiff S, Reinhold D (2000) Zinc deficiency and hepatic encephalopathy. Results of a long-term zinc supplementation. Trace Elem Exp Med 13:21–31CrossRef
Zurück zum Zitat Henglein-Ottermann D (1976) Der Einfluβ von Ornithin-Aspartat auf die Experimentell erzeugte Hyperammoniämie. Klinisch-experimentelle Studie. Therapie der Gegenwart 115:1504–1518PubMed Henglein-Ottermann D (1976) Der Einfluβ von Ornithin-Aspartat auf die Experimentell erzeugte Hyperammoniämie. Klinisch-experimentelle Studie. Therapie der Gegenwart 115:1504–1518PubMed
Zurück zum Zitat Ishiki Y, Ohnishi H, Muto Y, Matsumoto K, Nakamura T (1992) Direct evidence that hepatocyte growth factor is a hepatotrophic factor for liver regeneration and has a potent antihepatitis effect in vivo. Hepatology 16:1227–1235PubMed Ishiki Y, Ohnishi H, Muto Y, Matsumoto K, Nakamura T (1992) Direct evidence that hepatocyte growth factor is a hepatotrophic factor for liver regeneration and has a potent antihepatitis effect in vivo. Hepatology 16:1227–1235PubMed
Zurück zum Zitat Iwasa M, Matsumura K, Watanabe Y, Yamamoto M, Kaito M, Ikoma J et al (2003) Improvement of regional cerebral blood flow after treatment with branched-chain amino acid solutions in patients with cirrhosis. Eur J Gastroenterol Hepatol 15:733–737PubMedCrossRef Iwasa M, Matsumura K, Watanabe Y, Yamamoto M, Kaito M, Ikoma J et al (2003) Improvement of regional cerebral blood flow after treatment with branched-chain amino acid solutions in patients with cirrhosis. Eur J Gastroenterol Hepatol 15:733–737PubMedCrossRef
Zurück zum Zitat Jalan R, Kapoor D (2004) Reversal of diuretic-induced hepatic encephalopathy with infusion of albumin but not colloid. Clin Sci 106:467–474PubMedCrossRef Jalan R, Kapoor D (2004) Reversal of diuretic-induced hepatic encephalopathy with infusion of albumin but not colloid. Clin Sci 106:467–474PubMedCrossRef
Zurück zum Zitat Jalan R, Wright G, Davies NA, Hodges SJ (2007) L-ornithine-phenylacetate (OP): A novel treatment for hyperammonemia and hepatic encephalopathy. Med Hypotheses (in press) Jalan R, Wright G, Davies NA, Hodges SJ (2007) L-ornithine-phenylacetate (OP): A novel treatment for hyperammonemia and hepatic encephalopathy. Med Hypotheses (in press)
Zurück zum Zitat Kale RA, Gupta RK, Saraswat VA, Hasan KM, Trivedi R, Mishra AM et al (2006) Demonstration of interstitial cerebral edema with diffusion tensor MR imaging in type C hepatic encephalopathy. Hepatology 43:698–706PubMedCrossRef Kale RA, Gupta RK, Saraswat VA, Hasan KM, Trivedi R, Mishra AM et al (2006) Demonstration of interstitial cerebral edema with diffusion tensor MR imaging in type C hepatic encephalopathy. Hepatology 43:698–706PubMedCrossRef
Zurück zum Zitat Katayama K (2004) Ammonia metabolism and hepatic encephalopathy. Hepatol Res 30S:S71–S78 Katayama K (2004) Ammonia metabolism and hepatic encephalopathy. Hepatol Res 30S:S71–S78
Zurück zum Zitat Kircheis G, Metz M, Frey S, Seiller E (1996) Correlation between pharmacokinetic aspects and clinical efficacy of l-ornithine–l-aspartate (OA): results of randomized, controlled clinical trials. J Hepatol 25(1):131 Kircheis G, Metz M, Frey S, Seiller E (1996) Correlation between pharmacokinetic aspects and clinical efficacy of l-ornithine–l-aspartate (OA): results of randomized, controlled clinical trials. J Hepatol 25(1):131
Zurück zum Zitat Kircheis G, Nilius R, Held C, Berndt H, Buchner M, Gortelmeyer R et al (1997) Therapeutic efficacy of l-ornithine–l-aspartate infusions in patients with cirrhosis and hepatic encephalopathy: Results of a placebo-controlled double-blind study. Hepatology 25:1351–1360PubMedCrossRef Kircheis G, Nilius R, Held C, Berndt H, Buchner M, Gortelmeyer R et al (1997) Therapeutic efficacy of l-ornithine–l-aspartate infusions in patients with cirrhosis and hepatic encephalopathy: Results of a placebo-controlled double-blind study. Hepatology 25:1351–1360PubMedCrossRef
Zurück zum Zitat Kunin CM, Chalmers TC, Leevy CM, Sebastyen SC, Lieber CS, Finland M (1960) Absorption of orally administered neomycin and kanamycin with special reference to patients with severe hepatic and renal disease. N Engl J Med 262:380–385PubMedCrossRef Kunin CM, Chalmers TC, Leevy CM, Sebastyen SC, Lieber CS, Finland M (1960) Absorption of orally administered neomycin and kanamycin with special reference to patients with severe hepatic and renal disease. N Engl J Med 262:380–385PubMedCrossRef
Zurück zum Zitat Lai D, Gorbach SL, Levitan R (1972) Intestinal microflora in patients with alcoholic cirrhosis: urea-splitting bacteria and neomycin resistance. Gastroenterology 62:275–279PubMed Lai D, Gorbach SL, Levitan R (1972) Intestinal microflora in patients with alcoholic cirrhosis: urea-splitting bacteria and neomycin resistance. Gastroenterology 62:275–279PubMed
Zurück zum Zitat Lanthier PL, Morgan MY, Ballantyne J (1984) Bromocriptine-associated ototoxicity. J Laryngol Otol 98:399–404PubMed Lanthier PL, Morgan MY, Ballantyne J (1984) Bromocriptine-associated ototoxicity. J Laryngol Otol 98:399–404PubMed
Zurück zum Zitat Leevy CB, Phillips JA (2007) Hospitalizations during the use of rifaximin versus lactulose for the treatment of hepatic encephalopathy. Dig Dis Sci 52:737–741PubMedCrossRef Leevy CB, Phillips JA (2007) Hospitalizations during the use of rifaximin versus lactulose for the treatment of hepatic encephalopathy. Dig Dis Sci 52:737–741PubMedCrossRef
Zurück zum Zitat Leonhardt H, Bungert HJ (1972) Therapie der schweren Hyperammoniämie. Med Klin 67:1052–1056PubMed Leonhardt H, Bungert HJ (1972) Therapie der schweren Hyperammoniämie. Med Klin 67:1052–1056PubMed
Zurück zum Zitat Lighthouse J, Naito Y, Helmy A, Hotten P, Fuji H, Min CH et al (2004) Endotoxinemia and benzodiazepine-like substances in compensated cirrhotic patients: A randomized study comparing the effect of rifaximine alone and in association with a symbiotic preparation. Hepatol Res 28:155–160PubMedCrossRef Lighthouse J, Naito Y, Helmy A, Hotten P, Fuji H, Min CH et al (2004) Endotoxinemia and benzodiazepine-like substances in compensated cirrhotic patients: A randomized study comparing the effect of rifaximine alone and in association with a symbiotic preparation. Hepatol Res 28:155–160PubMedCrossRef
Zurück zum Zitat Liu Q, Duan ZP, Ha DK, Bengmark S, Kurtovic J, Riordan SM (2004) Synbiotic modulation of gut flora: effect on minimal hepatic encephalopathy in patients with cirrhosis. Hepatology 39:1441–1449PubMedCrossRef Liu Q, Duan ZP, Ha DK, Bengmark S, Kurtovic J, Riordan SM (2004) Synbiotic modulation of gut flora: effect on minimal hepatic encephalopathy in patients with cirrhosis. Hepatology 39:1441–1449PubMedCrossRef
Zurück zum Zitat Loguercio C, Abbiati R, Rinaldi M, Romano A, Del Vecchio Blanco C, Coltorti M (1995) Long-term effects of Enterococcus faecium SF68 versus lactulose in the treatment of patients with cirrhosis and grade 1–2 hepatic encephalopathy. J Hepatol 23:39–46CrossRef Loguercio C, Abbiati R, Rinaldi M, Romano A, Del Vecchio Blanco C, Coltorti M (1995) Long-term effects of Enterococcus faecium SF68 versus lactulose in the treatment of patients with cirrhosis and grade 1–2 hepatic encephalopathy. J Hepatol 23:39–46CrossRef
Zurück zum Zitat Loguercio C, Federico A, Tuccillo C, Terracciano F, D’Auria MV, De Simone C et al (2005) Beneficial effects of a probiotic VSL#3 on parameters of liver dysfunction in chronic liver diseases. J Clin Gastroenterol 39:540–543CrossRef Loguercio C, Federico A, Tuccillo C, Terracciano F, D’Auria MV, De Simone C et al (2005) Beneficial effects of a probiotic VSL#3 on parameters of liver dysfunction in chronic liver diseases. J Clin Gastroenterol 39:540–543CrossRef
Zurück zum Zitat Macbeth WA, Kass EH, McDermott WV Jr (1965) Treatment of hepatic encephalopathy by alteration of intestinal flora with Lactobacillus acidophilus. Lancet 191:399–403CrossRef Macbeth WA, Kass EH, McDermott WV Jr (1965) Treatment of hepatic encephalopathy by alteration of intestinal flora with Lactobacillus acidophilus. Lancet 191:399–403CrossRef
Zurück zum Zitat Malaguarnera M, Pistone G, Elivra R, Leotta C, Scarpello L, Liborio R (2005) Effect of l-carnitine in patients with hepatic encephalopathy. World J Gastroenterol 11:7197–7202PubMed Malaguarnera M, Pistone G, Elivra R, Leotta C, Scarpello L, Liborio R (2005) Effect of l-carnitine in patients with hepatic encephalopathy. World J Gastroenterol 11:7197–7202PubMed
Zurück zum Zitat Marchesini G, Fabr A, Bianchi G, Brizi M, Zoloi M (1996) Zinc supplementation and amino-acid nitrogen-metabolism in patients with advanced cirrhosis. Hepatology 23:1084–1092PubMedCrossRef Marchesini G, Fabr A, Bianchi G, Brizi M, Zoloi M (1996) Zinc supplementation and amino-acid nitrogen-metabolism in patients with advanced cirrhosis. Hepatology 23:1084–1092PubMedCrossRef
Zurück zum Zitat Marchesini G, Bianchi G, Merli M, Amodio P, Panella C, Loguercio C et al (2003) Nutritional supplementation with branched-chain amino acids in advanced cirrhosis: a double-blind, randomized trial. Gastroenterology 124:1792–1801PubMedCrossRef Marchesini G, Bianchi G, Merli M, Amodio P, Panella C, Loguercio C et al (2003) Nutritional supplementation with branched-chain amino acids in advanced cirrhosis: a double-blind, randomized trial. Gastroenterology 124:1792–1801PubMedCrossRef
Zurück zum Zitat Marshall AW, Jakobovits AW, Morgan MY (1982) Bromocriptine-associated hyponatraemia in cirrhosis. BMJ 285:1534–1535PubMed Marshall AW, Jakobovits AW, Morgan MY (1982) Bromocriptine-associated hyponatraemia in cirrhosis. BMJ 285:1534–1535PubMed
Zurück zum Zitat Mas A, Rodes J, Sunyer L, Rodrigo L, Planas R, Vargas V et al , Spanish Association for the Study of the Liver Hepatic Encephalopathy Cooperative Group (2003) Comparison of rifaximin and lactitol in the treatment of acute hepatic encephalopathy: Results of a randomized, double-blind, double-dummy, controlled clinical trial. J Hepatol 38:51–58PubMedCrossRef Mas A, Rodes J, Sunyer L, Rodrigo L, Planas R, Vargas V et al , Spanish Association for the Study of the Liver Hepatic Encephalopathy Cooperative Group (2003) Comparison of rifaximin and lactitol in the treatment of acute hepatic encephalopathy: Results of a randomized, double-blind, double-dummy, controlled clinical trial. J Hepatol 38:51–58PubMedCrossRef
Zurück zum Zitat Matsuda I, Ohtani Y, Ohyanagi K, Yamamoto S (1987) Hyperammonemia related to carnitine metabolism with particular emphasis on ornithine transcarbamylase deficiency. Enzyme 38:251–255PubMed Matsuda I, Ohtani Y, Ohyanagi K, Yamamoto S (1987) Hyperammonemia related to carnitine metabolism with particular emphasis on ornithine transcarbamylase deficiency. Enzyme 38:251–255PubMed
Zurück zum Zitat Morgan MY, Hawley KE (1987) Lactitol versus lactulose in the treatment of acute hepatic encephalopathy in cirrhotic patients: a double-blind, randomized trial. Hepatology 7:1278–1284PubMedCrossRef Morgan MY, Hawley KE (1987) Lactitol versus lactulose in the treatment of acute hepatic encephalopathy in cirrhotic patients: a double-blind, randomized trial. Hepatology 7:1278–1284PubMedCrossRef
Zurück zum Zitat Morgan MY, Jakobovits AW, James IM, Sherlock S (1980) Successful use of bromocriptine in the treatment of chronic hepatic encephalopathy. Gastroenterology 78:663–670PubMed Morgan MY, Jakobovits AW, James IM, Sherlock S (1980) Successful use of bromocriptine in the treatment of chronic hepatic encephalopathy. Gastroenterology 78:663–670PubMed
Zurück zum Zitat Morgan MY, Alonso M, Stanger LC (1989) Lactitol and lactulose for the treatment of subclinical hepatic encephalopathy in cirrhotic patients. J Hepatol 8:208–217PubMedCrossRef Morgan MY, Alonso M, Stanger LC (1989) Lactitol and lactulose for the treatment of subclinical hepatic encephalopathy in cirrhotic patients. J Hepatol 8:208–217PubMedCrossRef
Zurück zum Zitat Muto Y, Sato S, Watanabe A, Moriwaki H, Suzuki K, Kato A et al (2005) Effects of oral branched-chain amino acid granules on event-free survival in patients with liver cirrhosis. Clin Gastroenterol Hepatol 3:705–713PubMedCrossRef Muto Y, Sato S, Watanabe A, Moriwaki H, Suzuki K, Kato A et al (2005) Effects of oral branched-chain amino acid granules on event-free survival in patients with liver cirrhosis. Clin Gastroenterol Hepatol 3:705–713PubMedCrossRef
Zurück zum Zitat Neff GW, Kemmer N, Zacharias VC, Kaiser T, Duncan C, McHenry R et al (2006) Analysis of hospitalizations comparing rifaximin versus lactulose in the management of hepatic encephalopathy. Transplant Proc 38:3552–3555PubMedCrossRef Neff GW, Kemmer N, Zacharias VC, Kaiser T, Duncan C, McHenry R et al (2006) Analysis of hospitalizations comparing rifaximin versus lactulose in the management of hepatic encephalopathy. Transplant Proc 38:3552–3555PubMedCrossRef
Zurück zum Zitat Olde Damink SW, Deutz N, Redhead D, Hayes P, Soeters P, Jalan R (2002) Interorgan ammonia and amino acid metabolism in metabolically stable patients with cirrhosis and a TIPSS. Hepatology 36:1163–1171PubMedCrossRef Olde Damink SW, Deutz N, Redhead D, Hayes P, Soeters P, Jalan R (2002) Interorgan ammonia and amino acid metabolism in metabolically stable patients with cirrhosis and a TIPSS. Hepatology 36:1163–1171PubMedCrossRef
Zurück zum Zitat Olde Damink SW, Jalan R, Deutz NE, Redhead DN, Dejong CH, Hynd P et al (2003) The kidney plays a major role in the hyperammonemia seen after simulated or actual GI bleeding in patients with cirrhosis. Hepatology 37:1277–1285PubMedCrossRef Olde Damink SW, Jalan R, Deutz NE, Redhead DN, Dejong CH, Hynd P et al (2003) The kidney plays a major role in the hyperammonemia seen after simulated or actual GI bleeding in patients with cirrhosis. Hepatology 37:1277–1285PubMedCrossRef
Zurück zum Zitat Pedretti G, Calzetti C, Missale G, Fiaccadori F (1991) Rifaximin versus neomycin on hyperammoniemia in chronic portal systemic encephalopathy in cirrhotics. A double-blind, randomized trial. Ital J Gastroenterol 23:175–178PubMed Pedretti G, Calzetti C, Missale G, Fiaccadori F (1991) Rifaximin versus neomycin on hyperammoniemia in chronic portal systemic encephalopathy in cirrhotics. A double-blind, randomized trial. Ital J Gastroenterol 23:175–178PubMed
Zurück zum Zitat Poo JL, Gongora J, Sanchez-Avila F, Aguilar-Castillo S, Garcia-Ramos G, Fernandez-Zertuche M et al (2006) Efficacy of oral l-ornithine–l-aspartate in cirrhotic patients with hyperammonemic hepatic encephalopathy. Results of a randomized, lactulose-controlled study. Ann Hepatol 5:281–288PubMed Poo JL, Gongora J, Sanchez-Avila F, Aguilar-Castillo S, Garcia-Ramos G, Fernandez-Zertuche M et al (2006) Efficacy of oral l-ornithine–l-aspartate in cirrhotic patients with hyperammonemic hepatic encephalopathy. Results of a randomized, lactulose-controlled study. Ann Hepatol 5:281–288PubMed
Zurück zum Zitat Prasad AS, Rabbani P, Abasi A, Bowersox E (1978) Experimental zinc deficiency. Ann Intern Med 89:483–490PubMed Prasad AS, Rabbani P, Abasi A, Bowersox E (1978) Experimental zinc deficiency. Ann Intern Med 89:483–490PubMed
Zurück zum Zitat Prasad S, Dhiman RK, Duseja A, Chawla YK, Sharma A, Agarwal R (2007) Lactulose improves cognitive function and health-related quality of life in patients with cirrhosis who have minimal hepatic encephalopathy. Hepatology 45:549–559PubMedCrossRef Prasad S, Dhiman RK, Duseja A, Chawla YK, Sharma A, Agarwal R (2007) Lactulose improves cognitive function and health-related quality of life in patients with cirrhosis who have minimal hepatic encephalopathy. Hepatology 45:549–559PubMedCrossRef
Zurück zum Zitat Rabbani P, Prasad AS (1978) Plasma ammonia and liver ornithine carbamoyltransferase activity in zinc deficient rats. Am J Physiol 235:E203–E206PubMed Rabbani P, Prasad AS (1978) Plasma ammonia and liver ornithine carbamoyltransferase activity in zinc deficient rats. Am J Physiol 235:E203–E206PubMed
Zurück zum Zitat Raskind JY, El-Chaar GM (2000) The role of carnitine supplementation during valproic acid therapy. Ann Pharmacother 34:630–638PubMedCrossRef Raskind JY, El-Chaar GM (2000) The role of carnitine supplementation during valproic acid therapy. Ann Pharmacother 34:630–638PubMedCrossRef
Zurück zum Zitat Reding P, Duchateau J, Bataille C (1984) Oral zinc supplementation improves hepatic encephalopathy. Results of a randomized controlled trial. Lancet 2:493–494PubMedCrossRef Reding P, Duchateau J, Bataille C (1984) Oral zinc supplementation improves hepatic encephalopathy. Results of a randomized controlled trial. Lancet 2:493–494PubMedCrossRef
Zurück zum Zitat Rees CJ, Oppong K, Al Mardini H, Hudson M, Record CO (2000) Effect of l-ornithine–l-aspartate on patients with and without TIPS undergoing glutamine challenge: a double blind, placebo controlled trial. Gut 47:571–574PubMedCrossRef Rees CJ, Oppong K, Al Mardini H, Hudson M, Record CO (2000) Effect of l-ornithine–l-aspartate on patients with and without TIPS undergoing glutamine challenge: a double blind, placebo controlled trial. Gut 47:571–574PubMedCrossRef
Zurück zum Zitat Riggio O, Ariosto F, Merli M, Caschera M, Zullo A, Balducci G et al (1991) Short-term oral zinc supplementation does not improve chronic hepatic encephalopathy. Results of a double-blind crossover trial. Dig Dis Sci 36:1204–1208PubMedCrossRef Riggio O, Ariosto F, Merli M, Caschera M, Zullo A, Balducci G et al (1991) Short-term oral zinc supplementation does not improve chronic hepatic encephalopathy. Results of a double-blind crossover trial. Dig Dis Sci 36:1204–1208PubMedCrossRef
Zurück zum Zitat Riggio O, Merli M, Capocaccia L, Caschera M, Zullo A, Pinto G et al (1992) Zinc supplementation reduces blood ammonia and increases liver transcarbamylase activity in experimental cirrhosis. Hepatology 16:785–789PubMedCrossRef Riggio O, Merli M, Capocaccia L, Caschera M, Zullo A, Pinto G et al (1992) Zinc supplementation reduces blood ammonia and increases liver transcarbamylase activity in experimental cirrhosis. Hepatology 16:785–789PubMedCrossRef
Zurück zum Zitat Romero-Gómez M, Ramos-Guerrero R, Grande L, de Terán LC, Corpus R, Camacho I et al (2004) Intestinal glutaminase activity is increased in liver cirrhosis and correlates with minimal hepatic encephalopathy. J Hepatol 41:49–54PubMedCrossRef Romero-Gómez M, Ramos-Guerrero R, Grande L, de Terán LC, Corpus R, Camacho I et al (2004) Intestinal glutaminase activity is increased in liver cirrhosis and correlates with minimal hepatic encephalopathy. J Hepatol 41:49–54PubMedCrossRef
Zurück zum Zitat Rössle M, Nasari I, Ochs A, Haag K (1997) Effekt einer Zinksubstitution auf die Ammoniakkonzentration und die hepatische Enzephalopathie bei Patienten mit Zirrhose und Shunt. Z Gastroenterol 35(96):A155 Rössle M, Nasari I, Ochs A, Haag K (1997) Effekt einer Zinksubstitution auf die Ammoniakkonzentration und die hepatische Enzephalopathie bei Patienten mit Zirrhose und Shunt. Z Gastroenterol 35(96):A155
Zurück zum Zitat Schölmerich J (1987) Zinc and vitamin A in liver cirrhosis. In: Boyer JL, Bianchi L (eds) Liver cirrhosis. MTP, Lancaster, pp 421–432 Schölmerich J (1987) Zinc and vitamin A in liver cirrhosis. In: Boyer JL, Bianchi L (eds) Liver cirrhosis. MTP, Lancaster, pp 421–432
Zurück zum Zitat Shawcross D, Jalan R (2005) Dispelling myths in the treatment of hepatic encephalopathy. Lancet 365:431–433PubMed Shawcross D, Jalan R (2005) Dispelling myths in the treatment of hepatic encephalopathy. Lancet 365:431–433PubMed
Zurück zum Zitat Shawcross DL, Davies NA, Williams R, Jalan R (2004) Systemic inflammatory response exacerbates the neuropsychological effects of induced hyperammonaemia in cirrhosis. J Hepatol 40:247–254PubMedCrossRef Shawcross DL, Davies NA, Williams R, Jalan R (2004) Systemic inflammatory response exacerbates the neuropsychological effects of induced hyperammonaemia in cirrhosis. J Hepatol 40:247–254PubMedCrossRef
Zurück zum Zitat Shawcross DL, Wright G, Olde Damink SWM, Jalan R (2007) Role of ammonia and inflammation in minimal hepatic encephalopathy. Met Brain Dis 22:125–138CrossRef Shawcross DL, Wright G, Olde Damink SWM, Jalan R (2007) Role of ammonia and inflammation in minimal hepatic encephalopathy. Met Brain Dis 22:125–138CrossRef
Zurück zum Zitat Staedt U, Leweling H, Gladisch R, Kortsik C, Hagmuller E, Holm E (1993) Effects of ornithine aspartate on plasma ammonia and plasma amino acids in patients with cirrhosis. A double-blind, randomized study using a four-fold crossover design. J Hepatol 19:424–430PubMedCrossRef Staedt U, Leweling H, Gladisch R, Kortsik C, Hagmuller E, Holm E (1993) Effects of ornithine aspartate on plasma ammonia and plasma amino acids in patients with cirrhosis. A double-blind, randomized study using a four-fold crossover design. J Hepatol 19:424–430PubMedCrossRef
Zurück zum Zitat Stauch S, Kircheis G, Adler G, Beckh H, Ditschuneit H, Görtelmeyer R (1998) Oral l-ornithine–l-aspartate therapy of chronic hepatic encephalopathy: results of a placebo-controlled double-blind study. J Hepatol 28:856–864PubMedCrossRef Stauch S, Kircheis G, Adler G, Beckh H, Ditschuneit H, Görtelmeyer R (1998) Oral l-ornithine–l-aspartate therapy of chronic hepatic encephalopathy: results of a placebo-controlled double-blind study. J Hepatol 28:856–864PubMedCrossRef
Zurück zum Zitat Strauss E, Tramote R, Silva EP, Caly WR, Honain NZ, Maffei RA et al (1992) Double-blind randomized clinical trial comparing neomycin and placebo in the treatment of exogenous hepatic encephalopathy. Hepatogastroenterology 39:542–545PubMed Strauss E, Tramote R, Silva EP, Caly WR, Honain NZ, Maffei RA et al (1992) Double-blind randomized clinical trial comparing neomycin and placebo in the treatment of exogenous hepatic encephalopathy. Hepatogastroenterology 39:542–545PubMed
Zurück zum Zitat Sushma S, Dasarathy S, Tandon RK, Jain S, Gupta S, Bhist MS (1992) Sodium benzoate in the treatment of acute hepatic encephalopathy: a double-blind randomized trial. Hepatology 16:138–144PubMedCrossRef Sushma S, Dasarathy S, Tandon RK, Jain S, Gupta S, Bhist MS (1992) Sodium benzoate in the treatment of acute hepatic encephalopathy: a double-blind randomized trial. Hepatology 16:138–144PubMedCrossRef
Zurück zum Zitat Tomiya T, Inoue Y, Yanase M, Arai M, Ikeda H, Tejima K et al (2002) Leucine stimulates the secretion of hepatocyte growth factor by hepatic stellate cells. Biochem Biophys Res Commun 297:1108–1111PubMedCrossRef Tomiya T, Inoue Y, Yanase M, Arai M, Ikeda H, Tejima K et al (2002) Leucine stimulates the secretion of hepatocyte growth factor by hepatic stellate cells. Biochem Biophys Res Commun 297:1108–1111PubMedCrossRef
Zurück zum Zitat Uribe M, Rampollo O, Vargas F, Ravelli GP, Mundo F, Zapata L et al (1987) Acidifying enemas (lactitol and lactose) vs. nonacidifying enemas (tap water) to treat acute portal-systemic encephalopathy: a double-blind randomized clinical trial. Hepatology 7:639–643PubMedCrossRef Uribe M, Rampollo O, Vargas F, Ravelli GP, Mundo F, Zapata L et al (1987) Acidifying enemas (lactitol and lactose) vs. nonacidifying enemas (tap water) to treat acute portal-systemic encephalopathy: a double-blind randomized clinical trial. Hepatology 7:639–643PubMedCrossRef
Zurück zum Zitat Van der Rijt C, Schalm SW, Han S, Foelen K, De Jong G (1991) Overt hepatic encephalopathy precipitated by zinc deficiency. Gastroenterology 100:1114–1118PubMed Van der Rijt C, Schalm SW, Han S, Foelen K, De Jong G (1991) Overt hepatic encephalopathy precipitated by zinc deficiency. Gastroenterology 100:1114–1118PubMed
Zurück zum Zitat van Leeuwen PA, van Berlo CL, Soeters PB (1988) New mode of action for lactulose. Lancet i:55–56CrossRef van Leeuwen PA, van Berlo CL, Soeters PB (1988) New mode of action for lactulose. Lancet i:55–56CrossRef
Zurück zum Zitat Yamamoto M, Iwasa M, Matsumura K, Nakagawa Y, Fujita N, Kobayashi Y et al (2005) Improvement of regional cerebral blood flow after oral intake of branched-chain amino acids in patients with cirrhosis. World J Gastroenterol 11:6792–6799PubMed Yamamoto M, Iwasa M, Matsumura K, Nakagawa Y, Fujita N, Kobayashi Y et al (2005) Improvement of regional cerebral blood flow after oral intake of branched-chain amino acids in patients with cirrhosis. World J Gastroenterol 11:6792–6799PubMed
Zurück zum Zitat Yoshida Y, Higashi T, Nouso K, Nakatsukasa H, Nakamura S, Watanabe A et al (2001) Effects of zinc deficiency/zinc supplementation on ammonia metabolism in patients with decompensated liver cirrhosis. Acta Med Okayama 55:349–355PubMed Yoshida Y, Higashi T, Nouso K, Nakatsukasa H, Nakamura S, Watanabe A et al (2001) Effects of zinc deficiency/zinc supplementation on ammonia metabolism in patients with decompensated liver cirrhosis. Acta Med Okayama 55:349–355PubMed
Metadaten
Titel
The treatment of hepatic encephalopathy
verfasst von
Marsha Y. Morgan
A. Blei
K. Grüngreiff
R. Jalan
G. Kircheis
G. Marchesini
O. Riggio
Karin Weissenborn
Publikationsdatum
01.12.2007
Verlag
Springer US
Erschienen in
Metabolic Brain Disease / Ausgabe 3-4/2007
Print ISSN: 0885-7490
Elektronische ISSN: 1573-7365
DOI
https://doi.org/10.1007/s11011-007-9060-7

Weitere Artikel der Ausgabe 3-4/2007

Metabolic Brain Disease 3-4/2007 Zur Ausgabe

Introduction

Introduction

Leitlinien kompakt für die Neurologie

Mit medbee Pocketcards sicher entscheiden.

Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag

Akuter Schwindel: Wann lohnt sich eine MRT?

28.04.2024 Schwindel Nachrichten

Akuter Schwindel stellt oft eine diagnostische Herausforderung dar. Wie nützlich dabei eine MRT ist, hat eine Studie aus Finnland untersucht. Immerhin einer von sechs Patienten wurde mit akutem ischämischem Schlaganfall diagnostiziert.

Niedriger diastolischer Blutdruck erhöht Risiko für schwere kardiovaskuläre Komplikationen

25.04.2024 Hypotonie Nachrichten

Wenn unter einer medikamentösen Hochdrucktherapie der diastolische Blutdruck in den Keller geht, steigt das Risiko für schwere kardiovaskuläre Ereignisse: Darauf deutet eine Sekundäranalyse der SPRINT-Studie hin.

Frühe Alzheimertherapie lohnt sich

25.04.2024 AAN-Jahrestagung 2024 Nachrichten

Ist die Tau-Last noch gering, scheint der Vorteil von Lecanemab besonders groß zu sein. Und beginnen Erkrankte verzögert mit der Behandlung, erreichen sie nicht mehr die kognitive Leistung wie bei einem früheren Start. Darauf deuten neue Analysen der Phase-3-Studie Clarity AD.

Viel Bewegung in der Parkinsonforschung

25.04.2024 Parkinson-Krankheit Nachrichten

Neue arznei- und zellbasierte Ansätze, Frühdiagnose mit Bewegungssensoren, Rückenmarkstimulation gegen Gehblockaden – in der Parkinsonforschung tut sich einiges. Auf dem Deutschen Parkinsonkongress ging es auch viel um technische Innovationen.

Update Neurologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.