Zinc and Probiotic Therapy for Management of Hepatic Encephalopathy

Abstract

Hepatic encephalopathy is a complication of decompensated liver disease that consumes considerable health care resources and has a negative impact on quality of life. For several decades, maintenance therapy with lactulose has been considered the standard of care, but emerging data from clinical trials demonstrate that other therapeutic options may be available and could have a better tolerability profile than lactulose. This brief review will discuss the pathophysiology of hepatic encephalopathy and proposed mechanisms of action of zinc and probiotics in this context, discussing the findings of key trials.

AASLD Practice Guidance: Palliative care and symptom‐based management in decompensated cirrhosis

“…[ 7 ] Also, zinc repletion, branched‐chain amino acids (BCAAs), probiotics, and, possibly, carnitine can be offered as adjuvant therapies. [ 7,181–183 ]…”

“…[7] Also, zinc repletion, branched-chain amino acids (BCAAs), probiotics, and, possibly, carnitine can be offered as adjuvant therapies. [7,[181][182][183] Guidance statements 37. Evaluating reversible causes and addressing HE can benefit both patient and caregiver quality of life.…”

Gut Microbiota as a Mediator of Essential and Toxic Effects of Zinc in the Intestines and Other Tissues

“…At the same time, co-supplementation of Zn and microencapsulated Lactobacillus plantarum IS-10506 in preschool children did not have added advantages on the effects on fecal IgA levels in comparison to treatment with a probiotic alone; although improved Zn status was proposed to be beneficial for immunity [ 99 ]. Probiotic and Zn co-supplementation has also been proposed as a potential tool for the management of hepatic encephalopathy [ 100 ].…”