Hepatic Encephalopathy: Current and Emerging Treatment Modalities

Fallahzadeh, Mohammad Amin; Rahimi, Robert S.

doi:10.1016/j.cgh.2022.04.034

Cited by 21 publications

(17 citation statements)

References 106 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“… 1 2 The precise pathogenesis of HE remains incompletely understood, with current focus primarily centred on the theory that ammonia toxicity is the underlying mechanism. 3 In patients with decompensated cirrhosis, the incidence of overt HE ranges from 30% to 45%. 4 HE represents a critical contributor to the mortality rate among patients with end-stage liver disease.…”

Section: Introductionmentioning

confidence: 99%

Interventional embolisation for patients with cirrhosis and recurrent or persistent hepatic encephalopathy related to spontaneous portosystemic shunts: protocol for a prospective, non-randomised controlled study

Ke,

Lin,

Lei

et al. 2024

BMJ Open

View full text Add to dashboard Cite

IntroductionThe presence of spontaneous portosystemic shunts (SPSS) has been identified to be associated with hepatic encephalopathy (HE) in patients with cirrhosis. Nevertheless, the role of interventional embolisation in managing such patients remains poorly defined. Consequently, this prospective controlled study aims to assess the efficacy and safety of interventional embolisation as a therapeutic approach for patients with cirrhosis and recurrent or persistent HE related to SPSS.Methods and analysisCirrhotic patients diagnosed with recurrent or persistent HE associated with SPSS will be recruited for this study, and assigned to either the interventional embolisation group or the standard medical treatment group. The efficacy endpoints encompass the evaluation of postoperative alleviation of HE symptoms and the incidence of overt HE recurrence during the follow-up period, as well as the duration and frequency of hospitalisations for HE, alterations in liver function and volume, and overall survival. The safety endpoints encompass both immediate and long-term postoperative complications.Ethics and disseminationThis study will be conducted in strict adherence to the principles of good clinical practice and the guidelines outlined in the Declaration of Helsinki. Ethical approval for the trial has been obtained from the Ethics Committee of Mengchao Hepatobiliary Hospital of Fujian Medical University (2023_013_02). Written informed consent will be obtained from all the participants by the treating physician for each patient prior to their enrolment. The documented informed consent forms will be retained as part of the clinical trial records for future reference. The study findings will be disseminated through publication in peer-reviewed journals and will be presented at international conferences.Trial registration numberChiCTR2300072189.

show abstract

Section: Introductionmentioning

confidence: 99%

Interventional embolisation for patients with cirrhosis and recurrent or persistent hepatic encephalopathy related to spontaneous portosystemic shunts: protocol for a prospective, non-randomised controlled study

Ke,

Lin,

Lei

et al. 2024

BMJ Open

View full text Add to dashboard Cite

show abstract

“…Although several published reviews have elucidated the involvement of gut microbiota dysbiosis in the pathogenesis and treatment of HE, no specific review has focused on this involvement in MHE[ 13 , 18 - 20 ]. Therefore, this review aimed to comprehensively elucidate the roles of gut microbiota in MHE pathogenesis via the gut-liver-brain axis and systematically analyze the underlying mechanisms linked with microbiome therapies to modulate gut microbiota dysbiosis in cirrhotic patients with MHE.…”

Section: Introductionmentioning

confidence: 99%

Role of gut microbiota in the pathogenesis and therapeutics of minimal hepatic encephalopathy via the gut-liver-brain axis

Luo¹,

Xin²,

Hu³

et al. 2023

World J Gastroenterol

View full text Add to dashboard Cite

Minimal hepatic encephalopathy (MHE) is a frequent neurological and psychiatric complication of liver cirrhosis. The precise pathogenesis of MHE is complicated and has yet to be fully elucidated. Studies in cirrhotic patients and experimental animals with MHE have indicated that gut microbiota dysbiosis induces systemic inflammation, hyperammonemia, and endotoxemia, subsequently leading to neuroinﬂammation in the brain via the gut-liver-brain axis. Related mechanisms initiated by gut microbiota dysbiosis have significant roles in MHE pathogenesis. The currently available therapeutic strategies for MHE in clinical practice, including lactulose, rifaximin, probiotics, synbiotics, and fecal microbiota transplantation, exert their effects mainly by modulating gut microbiota dysbiosis. Microbiome therapies for MHE have shown promised efficacy and safety; however, several controversies and challenges regarding their clinical use deserve to be intensively discussed. We have summarized the latest research ﬁndings concerning the roles of gut microbiota dysbiosis in the pathogenesis of MHE via the gut-liver-brain axis as well as the potential mechanisms by which microbiome therapies regulate gut microbiota dysbiosis in MHE patients.

show abstract

“…HE manifests as a wide spectrum of neuropsychiatric abnormalities, from subclinical changes (mild cognitive impairment) to marked disorientation, confusion, coma and even death in the worst scenarios [ 2 ]. The impaired quality of life of patients together with the morbidity and mortality of this syndrome impose a significant economic burden on caregivers and the healthcare system [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

“…Its conversion to short-chain organic acids by gut bacteria results in reduced colonic pH that inhibits the proliferation of colonic bacteria and ammonia production. An acidic environment, on the one hand, destroys urease-producing bacteria involved in the production of ammonia [ 14 ] and, on the other hand, may also facilitate ammonia absorption, promoting the conversion of ammonia (NH 3 ) to ammonium (NH 4 + ) [ 3 ]. A meta-analysis including descriptive information from 38 randomized clinical trials with 1828 participants and quantitative data from 34 randomized clinical trials with 1764 participants revealed that treatment with non-absorbable disaccharides (including lactulose and lactitol) reduced mortality in patients with overt HE and decreased the risk of developing HE in the longer term compared to placebo/no intervention groups [ 15 , 16 ].…”

Section: Introductionmentioning

confidence: 99%

Active Clinical Trials in Hepatic Encephalopathy: Something Old, Something New and Something Borrowed

Balzano

2023

Neurochem Res

View full text Add to dashboard Cite

Hepatic encephalopathy (HE) is a potentially reversible neurocognitive syndrome that occurs in patients with acute or chronic liver disease. Currently, most of the therapies for HE aim to reduce ammonia production or increase its elimination. To date, only two agents have been approved as treatments for HE: lactulose and rifaximin. Many other drugs have also been used, but data to support their use are limited, preliminary or lacking. The aim of this review is to provide an overview and discussion of the current development of treatments for HE. Data from ongoing clinical trials in HE were obtained from the ClinicalTrials.gov website, and a breakdown analysis of studies that were active on August 19th, 2022, was performed. Seventeen registered and ongoing clinical trials for therapeutics targeting HE were identified. More than 75% of these agents are in phase II (41.2%) or in phase III (34.7%). Among them, there are many old acquaintances in the field, such as lactulose and rifaximin, some new entries such as fecal microbiota transplantation and equine anti-thymocyte globulin, an immunosuppressive agent, but also some therapies borrowed from other conditions, such as rifamycin SV MMX and nitazoxanide, two antimicrobial agents FDA approved for the treatment of some types of diarrheas or VE303 and RBX7455, two microbiome restoration therapies, currently used as treatment of high-risk Clostridioides difficile infections. If working, some of these drugs could soon be used as valid alternatives to current therapies when ineffective or be approved as novel therapeutic approaches to improve the quality of life of HE patients. Supplementary Information The online version contains supplementary material available at 10.1007/s11064-023-03916-w.

show abstract

Hepatic Encephalopathy: Current and Emerging Treatment Modalities

Cited by 21 publications

References 106 publications

Interventional embolisation for patients with cirrhosis and recurrent or persistent hepatic encephalopathy related to spontaneous portosystemic shunts: protocol for a prospective, non-randomised controlled study

Interventional embolisation for patients with cirrhosis and recurrent or persistent hepatic encephalopathy related to spontaneous portosystemic shunts: protocol for a prospective, non-randomised controlled study

Role of gut microbiota in the pathogenesis and therapeutics of minimal hepatic encephalopathy via the gut-liver-brain axis

Active Clinical Trials in Hepatic Encephalopathy: Something Old, Something New and Something Borrowed

Contact Info

Product

Resources

About