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Hepatic Encephalopathy

Confusion, mental dullness, drowsiness and even coma caused by liver failure. NIH - National Institute of Diabetes and Digestive and Kidney Diseases and National Library of Medicine

About Hepatic Encephalopathy

A failing liver cannot remove toxins from the blood, so they eventually accumulate in the brain. The buildup of toxins in the brain is called hepatic encephalopathy. This condition can decrease mental function and cause stupor and even coma. Stupor is an unconscious, sleeplike state from which a person can only be aroused briefly by a strong stimulus, such as a sharp pain. Coma is an unconscious, sleeplike state from which a person cannot be aroused. Signs of decreased mental function include

  • confusion
  • personality changes
  • memory loss
  • trouble concentrating
  • a change in sleep habits

NIH - National Institute of Diabetes and Digestive and Kidney Diseases

What works? Research summarized

Evidence reviews

[Efficacy of probiotics in the treatment of minimal hepatic encephalopathy: a meta-analysis]

Bibliographic details: Tang SH, Wang KJ, Wu XJ, Zhang MM.  [Efficacy of probiotics in the treatment of minimal hepatic encephalopathy: a meta-analysis]. World Chinese Journal of Digestology 2011; 19(24): 2587-2592 Available from: http://caod.oriprobe.com/articles/28260148/Efficacy_of_probiotics_in_the_treatment_of_minimal_hepatic_encephalopa.htm

Efficacy of L-ornithine-L-aspartate in the treatment of hepatic encephalopathy: a systematic review

Bibliographic details: Hu W, Tang SH.  Efficacy of L-ornithine-L-aspartate in the treatment of hepatic encephalopathy: a systematic review. Chinese Journal of Evidence-Based Medicine 2012; 12(7): 799-803 Available from: http://www.cjebm.org.cn/oa/DArticle.aspx?type=view&id=2012070011

Meta-analysis: the effects of gut flora modulation using prebiotics, probiotics and synbiotics on minimal hepatic encephalopathy

BACKGROUND: Minimal hepatic encephalopathy (MHE) is characterised by subtle neurocognitive deficits without overt clinical manifestations. Although several trials have individually evaluated the role of prebiotics, probiotics and synbiotics, there is yet no consensus on the management of MHE.

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Summaries for consumers

Flumazenil causes short‐term improvement of hepatic encephalopathy in patients with chronic liver disease

Hepatic encephalopathy refers to changes in mental state, ranging from minor signs of altered brain function to deep coma occurring in patients with liver failure. Hepatic encephalopathy may be caused by an activation of a receptor‐complex in the brain. Flumazenil, which inhibits this receptor‐complex, might ameliorate the symptoms. This review found that flumazenil leads to a short‐term improvement of hepatic encephalopathy in some patients with chronic liver disease and a highly favourable prognosis.

There is insufficient evidence to confirm or exclude whether nonabsorbable disaccharides have an effect on patients with hepatic encephalopathy

Nonabsorbable disaccharides (lactulose or lactitol) are considered the treatment of choice for hepatic encephalopathy. When all the identified trials were combined, nonabsorbable disaccharides appeared to have a modest effect on improving encephalopathy. However, this effect was not seen when only trials of high quality were analysed. Antibiotics appeared to be superior to nonabsorbable disaccharides in improving hepatic encephalopathy, but it is unclear whether this difference in treatment effect is important to patients. Too few patients have been randomised to establish whether lactulose and lactitol have comparable effect.

Portosystemic shunts compared with sclerotherapy/banding lowers variceal rebleeding, but increases hepatic encephalopathy

A third of deaths from cirrhosis are due to variceal bleeding. Randomised clinical trials have compared three types of portosystemic shunting separately against endoscopic therapy. The shunts included in these trials have been total portocaval shunts, distal splenorenal shunts, and transjugular intrahepatic portocaval shunts. The authors found that when compared to endoscopic therapy all three types of shunt lowered the rate of rebleeding at the cost of a higher incidence of hepatic encephalopathy, without any statistically significant difference in survival.

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More about Hepatic Encephalopathy

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Also called: Hepatocerebral encephalopathy, Gaustad's syndrome, Portal systemic encephalopathy, Transient hepatargy syndrome, Portal-systemic encephalopathy, HE

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