Pickle Juice Intervention for Cirrhotic Cramps Reduction: The PICCLES Randomized Controlled Trial

Tapper, Elliot B.; Salim, Najat; Baki, Jad; Zhao, Zhe; Sundaram, Vinay; Patwardhan, Vilas; Nikirk, Samantha

doi:10.14309/ajg.0000000000001781

Cited by 16 publications

(15 citation statements)

References 21 publications

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“…Cirrhosis is associated with multiple common physical and psychological symptoms that can be improved with treatment (Table 2). In an RCT of 80 patients, compared with tap water, 1 sip of pickle brine at cramp onset significantly reduced cramp severity at 28-day follow-up (2.3- vs 0.4-point reduction on a 10-point visual analog scale) . In a 2-week randomized, double-blind, crossover trial of 30 patients, compared with placebo, 1000 mg of taurine twice daily significantly reduced leg cramping (7 fewer cramps compared with placebo) .…”

Section: Discussionmentioning

confidence: 99%

“…Pickle juice: reduction of 2.3 points on VAS for cramp severity compared with 0.4 for a tap-water control among 80 patients in a randomized trial…”

Section: Discussionmentioning

confidence: 99%

“…People with cirrhosis have reduced quality of life . Poor quality of life is associated with many common symptoms such as muscle cramps, poor-quality sleep, pruritus, and sexual dysfunction, which can be improved with therapy.…”

Section: Introductionmentioning

confidence: 99%

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Diagnosis and Management of Cirrhosis and Its Complications

Tapper

Parikh

2023

JAMA

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ImportanceCirrhosis affects approximately 2.2 million adults in the US. From 2010 to 2021, the annual age-adjusted mortality of cirrhosis increased from 14.9 per 100 000 to 21.9 per 100 000 people.ObservationsThe most common causes of cirrhosis in the US, which can overlap, include alcohol use disorder (approximately 45% of all cases of cirrhosis), nonalcoholic fatty liver disease (26%), and hepatitis C (41%). Patients with cirrhosis experience symptoms including muscle cramps (approximately 64% prevalence), pruritus (39%), poor-quality sleep (63%), and sexual dysfunction (53%). Cirrhosis can be diagnosed by liver biopsy but may also be diagnosed noninvasively. Elastography, a noninvasive assessment of liver stiffness measured in kilopascals, can typically confirm cirrhosis at levels of 15 kPa or greater. Approximately 40% of people with cirrhosis are diagnosed when they present with complications such as hepatic encephalopathy or ascites. The median survival time following onset of hepatic encephalopathy and ascites is 0.92 and 1.1 years, respectively. Among people with ascites, the annual incidence of spontaneous bacterial peritonitis is 11% and of hepatorenal syndrome is 8%; the latter is associated with a median survival of less than 2 weeks. Approximately 1% to 4% of patients with cirrhosis develop hepatocellular carcinoma each year, which is associated with a 5-year survival of approximately 20%. In a 3-year randomized clinical trial of 201 patients with portal hypertension, nonselective β-blockers (carvedilol or propranolol) reduced the risk of decompensation or death compared with placebo (16% vs 27%). Compared with sequential initiation, combination aldosterone antagonist and loop diuretics were more likely to resolve ascites (76% vs 56%) with lower rates of hyperkalemia (4% vs 18%). In meta-analyses of randomized trials, lactulose was associated with reduced mortality relative to placebo (8.5% vs 14%) in randomized trials involving 705 patients and reduced risk of recurrent overt hepatic encephalopathy (25.5% vs 46.8%) in randomized trials involving 1415 patients. In a randomized clinical trial of 300 patients, terlipressin improved the rate of reversal of hepatorenal syndrome from 39% to 18%. Trials addressing symptoms of cirrhosis have demonstrated efficacy for hydroxyzine in improving sleep dysfunction, pickle brine and taurine for reducing muscle cramps, and tadalafil for improving sexual dysfunction in men.Conclusions and RelevanceApproximately 2.2 million US adults have cirrhosis. Many symptoms, such as muscle cramps, poor-quality sleep, pruritus, and sexual dysfunction, are common and treatable. First-line therapies include carvedilol or propranolol to prevent variceal bleeding, lactulose for hepatic encephalopathy, combination aldosterone antagonists and loop diuretics for ascites, and terlipressin for hepatorenal syndrome.

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Section: Discussionmentioning

confidence: 99%

“…Pickle juice: reduction of 2.3 points on VAS for cramp severity compared with 0.4 for a tap-water control among 80 patients in a randomized trial…”

Section: Discussionmentioning

confidence: 99%

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Diagnosis and Management of Cirrhosis and Its Complications

Tapper

Parikh

2023

JAMA

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“…Subsequently, in June of 2022, we published the PICCLES trial of pickle juice for cramps in cirrhotics. This study concluded that sips of pickle juice at onset of cramps improve cramp severity without adverse events (2). This clinically relevant and readily available home remedy can improve the quality of life for our patients.…”

Section: What Has Ajg Done To Enhance the Reader's Experience?mentioning

confidence: 96%

The American Journal of Gastroenterology: Reflections on 2022 and the Road Ahead

Long

Bajaj

2023

Am J Gastroenterol

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“…Our interventional studies are of the highest quality, including a number of randomized controlled trials (RCTs). Many patients with liver disease struggle with uncontrolled cramping, in this issue Tapper et al provide data from a RCT of pickle juice for reduction of cramps (PICCLES) (2). Read on for data on this simple, sweet and salty way to improve our patients' symptoms.…”

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confidence: 99%