Effects of Branched-Chain Amino Acids Supplementation in Patients With Cirrhosis and a Previous Episode of Hepatic Encephalopathy: A Randomized Study

Les, Íñigo; Diéguez, Eduardo Doval; García-Martinez, Rita; Planas, M.; Cárdenas, Guillermo; Gómez, Pilar; Flavià, Montse; Jacas, Carlos; Mínguez, Beatriz; Vergara, Mercedes; Soriano, Germán; Vila, Carmen; Esteban, Rafael; Córdoba, Juan

doi:10.1038/ajg.2011.9

Cited by 158 publications

(122 citation statements)

References 32 publications

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“…Aminoacidi a catena ramificata: diminuiscono i livelli di aminoacidi aromatici coinvolti nelle alterazioni della neurotrasmissione in corso di EE e riducono il catabolismo proteico e la conseguente produzione di ammonio da parte del tessuto muscolare. Le evidenze della loro utilità clinica sono limitate [100,101], sebbene ne sia stata dimostrata l' efficacia, in particolare, nell'EE precipitata dal sanguinamento gastrointestinale [103]. L-ornitina-L-aspartato (LOLA): recenti evidenze sostengono l'utilizzo del LOLA, in quanto si è dimostrato in grado di diminuire i livelli di ammonio, migliorare lo stato mentale e le performace cognitive dei pazienti con cirrosi epatica [104,105].…”

Section: Terapia Domiciliareunclassified

A look at the hepatic encephalopathy in cirrhosis

Zaccherini

Tufoni

Ricci

et al. 2013

RHC

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Hepatic encephalopathy (HE) is a neuropsychiatric syndrome complicating acute and chronic liver failure and characterized by a wide range of manifestations, in absence of other brain disease. HE is very frequent in course of cirrhosis and even mild forms involve a great additional burden on patients, their families and health-care resources. Its onset affects subsequent survival of patients. Historically, pathophysiology of HE was connected to several substances (mostly ammonia) produced in the gut and normally metabolized by the liver, but more recently other factors such as inflammation, bacterial translocation and oxidative stress have shown a crucial role. Symptoms are often overt (confusion, asterixis, disorientation, ataxia or coma) but can also be subtle (sleep disturbances, cognitive impairment, mood alterations, impairment of executive decision-making, and psychomotor speed -Minimal HE); the West Haven Criteria are most often used to grade Overt HE (OHE), with grade ranging from 0 to 4 (4 corresponding to coma). Since both Minimal HE and grade 1 HE cannot be diagnosed by clinical examination and need for specific tests, it results practical to combine these entities and name them "Covert" HE (CHE) to aid clinical use. Diagnosis is based on evidence of neurological impairment in presence of liver cirrhosis, only after the exclusion of other brain diseases. Measurement of serum ammonia and electroencephalography are little specific, while brain magnetic resonance and search for portosystemic shunts are important in complex cases. Diagnosis of OHE is often just clinical, while that of CHE requires dedicated psychometric and neurophysiological tests. Although these tests are difficult to be performed in the clinical practice, detection and treatment of CHE are cost-effective and important; indeed, CHE affects patients' quality of life, socioeconomic status and driving skills, and increases the risk for falls, car accidents, development of OHE, and death. Management of HE includes early diagnosis and prompt treatment of precipitating factors (infection, gastrointestinal bleeding, electrolyte disturbances, dehydration, hypotension, use of benzodiazepines, psychoactive drugs, and/or alcohol). Current treatment is based principally on reducing intestinal ammonia with nonabsorbable disaccharides (lactulose or lactitol); rifaximin, used solely or in addition, is also becoming a first-line treatment. Keywords Liver cirrhosis; Overt hepatic encephalopathy; Covert hepatic encephalopathy; Minimal hepatic encephalopathy Uno sguardo all'encefalopatia epatica nella cirrosiA look at the hepatic encephalopathy in cirrhosis Uno sguardo all'encefalopatia epatica nella cirrosi Introduzione L' encefalopatia epatica (EE) è una forma di sofferenza cerebrale che spesso complica il decorso della cirrosi epatica. L'EE è caratterizzata da un ampio spettro di alterazioni neuropsicologiche e neuropsichiatriche, con differenti livelli di severità, da forme subcliniche fino a stupor e coma, in assenza di altre patologie cerebra...

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Section: Terapia Domiciliareunclassified

A look at the hepatic encephalopathy in cirrhosis

Zaccherini

Tufoni

Ricci

et al. 2013

RHC

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“…Although oral BCAA supplementation after an episode of hepatic encephalopathy does not decrease recurrence of hepatic encephalopathy, it relieves minimal hepatic encephalopathy and increases muscle mass. [14]. It is also associated with reduced incidence of HCC in patients with Child-Pugh A cirrhosis [15] and in patients with a BMI of 25 kg/m 2 or higher [16].…”

Section: Diagnosis Of Liver Cirrhosismentioning

confidence: 99%

“…It prevents progressive hepatic failure, improves surrogate markers, improves perceived health status [210], and improves event-free survival in patients with decompensated cirrhosis with an adequate daily food intake [10]. It relieves minimal hepatic encephalopathy, improves neuropsychological test scores, and increases the muscle mass [14]. It may inhibit hepatic carcinogenesis in patients with compensated cirrhosis with a serum albumin level of less than 4.0 g/dL [11].…”

Section: Cq: Is Albumin Infusion Effective For Treatment Of Cirrhoticmentioning

confidence: 99%

Evidence-based clinical practice guidelines for liver cirrhosis 2015

et al. 2016

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The Japanese Society of Gastroenterology revised the evidence-based clinical practice guidelines for liver cirrhosis in 2015. Eighty-three clinical questions were selected, and a literature search was performed for the clinical questions with use of the MEDLINE, Cochrane, and Igaku Chuo Zasshi databases for the period between 1983 and June 2012. Manual searching of the latest important literature was added until August 2015. The guidelines were developed with use of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. This digest version in English introduces selected clinical questions and statements related to the management of liver cirrhosis and its complications. Branched-chain amino acids relieve hypoalbuminemia and hepatic encephalopathy and improve quality of life. Nucleoside analogues and peginterferon plus ribavirin combination therapy improve the prognosis of patients with hepatitis B virus related liver cirrhosis and hepatitis C related compensated liver cirrhosis, respectively, although the latter therapy may be replaced by direct-acting antivirals. For liver cirrhosis caused by primary biliary cirrhosis and active autoimmune hepatitis, urosodeoxycholic acid and steroid are recommended, respectively. The most adequate modalities for the management of variceal bleeding are the endoscopic injection sclerotherapy for esophageal varices and the balloon-occluded retrograde transvenous obliteration following endoscopic obturation with cyanoacrylate for gastric varices. Beta-blockers are useful for primary prophylaxis of esophageal variceal bleeding. The V 2 receptor antagonist tolvaptan is a useful add-on therapy in careful diuretic therapy for ascites. Albumin infusion is useful for the prevention of paracentesis-induced circulatory disturbance and renal failure. In addition to disaccharides, the nonabsorbable antibiotic rifaximin is useful for the management of encephalopathy. Anticoagulation therapy is proposed for patients with acute-onset or progressive portal vein thrombosis.

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“…Some studies have demonstrated improvements in HE with improved nutritional parameters. Unfortunately, BCAA preparations have important limitations: poor palatability, high cost, and lack of availability in Turkey (22,23). Moreover, alterations in lipid metabolism occur by several mechanisms, and guidelines suggest that fat should be provided at a minimum of 25%-30% of the total daily calories (8,19).…”

Section: Macronutrientsmentioning

confidence: 99%

Importance of malnutrition in patients with cirrhosis

Gokturk

Şelçuk²

2015

Turk J Gastroenterol

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Malnutrition is common in patients with chronic liver disease and is associated with poor outcomes. Inadequate intake, poor quality diet, maldigestion, malabsorption, altered macronutrient metabolism, and hypermetabolism all contribute to the development of malnutrition in this patient population. Although it is generally easy to detect, clinicians often overlook malnutrition and its measurement is complicated by the lack of a simple, standardized diagnostic method. Early detection of malnutrition and multidisciplinary treatment approaches greatly increase the probability for successful outcomes.

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Effects of Branched-Chain Amino Acids Supplementation in Patients With Cirrhosis and a Previous Episode of Hepatic Encephalopathy: A Randomized Study

Cited by 158 publications

References 32 publications

A look at the hepatic encephalopathy in cirrhosis

A look at the hepatic encephalopathy in cirrhosis

Evidence-based clinical practice guidelines for liver cirrhosis 2015

Importance of malnutrition in patients with cirrhosis

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