Treatment of hepatic encephalopathy in patients with cirrhosis of the liver.
The treatment of hepatic encephalopathy is predominantly an empirical approach because the process pathogenesis of this syndrome is uncertain. Many treatment trials have been published, but few fulfill the usually accepted criteria for optimum study design. Lack of placebo controls, inadequate sample size and the difficulty in assessing the severity of encephalopathy are noteworthy examples. Treatments based on reducing ammoniagenic factors in the intestinal tract and promoting urinary waste nitrogen elimination are discussed. Other forms of therapy based on the false neurotransmitter and gamma-aminobutyric hypotheses are reviewed before outlining a practical approach to treatment of hepatic encephalopathy in clinical practice.
Ferenci
P
P
Department of Internal Medicine IV, Gastroenterology and Hepatology, University of Vienna, Austria.
D000597:Amino Acids, Branched-Chain / Q000627:therapeutic use; D000641:Ammonia / Q000037:antagonists & inhibitors; D002986:Clinical Trials as Topic; D006501:Hepatic Encephalopathy / Q000209:etiology / Q000378:metabolism / Q000628:therapy*; D006801:Humans; D007413:Intestinal Mucosa / Q000378:metabolism; D008103:Liver Cirrhosis / Q000150:complications*; D018377:Neurotransmitter Agents / Q000627:therapeutic use; D009584:Nitrogen / Q000652:urine; D010919:Placebos; D012107:Research Design; D018401:Sample Size; D005680:gamma-Aminobutyric Acid / Q000627:therapeutic use
D000597:Amino Acids, Branched-Chain; D018377:Neurotransmitter Agents; D010919:Placebos; D005680:gamma-Aminobutyric Acid; D000641:Ammonia; D009584:Nitrogen