title: [Hepatic encephalopathy and liver transplantation].
abstract: About 6500-7000 people/year die in Hungary due to liver cirrhosis which is often complicated with hepatic encephalopathy (HE). While conventional interpretation is that hepatic encephalopathy is a consequence of high blood ammonia level, recent data indicate that the degree of encephalopathy is related to systemic inflammatory response during decompensation. In this review the authors overview and analyze the latest treatment modalities of hepatic encephalopathy based on most recent findings. They found that frequently used evidence based treatment which apply metronidazole, neomycine or disaccharides was only partially effective in clinical studies. Use of rifaximine only is supported by grade I evidence, however it is quite a costly drug. The authors could not identify a generally accepted guideline for the treatment of HE with a systematic literature review, although it has significant effect on survival after liver transplantation. Therefore, the authors urge to develop a consensus guideline for the treatment of HE.
authors.affiliation: Semmelweis Egyetem Transzplantációs és Sebészeti Klinika, Budapest. drfehervariimre@t-online.hu
authors.forename: Imre
authors.initials: I
authors.lastname: Fehérvári
authors.forename: Balázs
authors.initials: B
authors.lastname: Nemes
authors.forename: Dénes
authors.initials: D
authors.lastname: Görög
authors.forename: Zsuzsa
authors.initials: Z
authors.lastname: Gerlei
authors.forename: László
authors.initials: L
authors.lastname: Kóbori
mesh_terms: D000641:Ammonia / Q000037:antagonists & inhibitors / Q000097:blood / Q000378:metabolism*; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D003106:Colon / Q000382:microbiology; D004151:Dipeptides / Q000627:therapeutic use; D004187:Disaccharides / Q000627:therapeutic use; D058625:End Stage Liver Disease / Q000188:drug therapy* / Q000209:etiology / Q000378:metabolism / Q000382:microbiology / Q000401:mortality / Q000601:surgery*; D019317:Evidence-Based Medicine; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D006501:Hepatic Encephalopathy / Q000188:drug therapy* / Q000209:etiology / Q000378:metabolism / Q000382:microbiology / Q000401:mortality / Q000601:surgery*; D006801:Humans; D006814:Hungary / Q000453:epidemiology; D006863:Hydrogen-Ion Concentration; D007778:Lactobacillus / Q000187:drug effects / Q000254:growth & development; D007792:Lactulose / Q000627:therapeutic use; D054368:Laxatives / Q000627:therapeutic use; D008103:Liver Cirrhosis / Q000150:complications* / Q000188:drug therapy / Q000378:metabolism / Q000401:mortality; D016031:Liver Transplantation; D008795:Metronidazole / Q000627:therapeutic use; D009355:Neomycin / Q000627:therapeutic use; D012294:Rifamycins / Q000627:therapeutic use; D000078262:Rifaximin; D012720:Severity of Illness Index; D013402:Sugar Alcohols / Q000627:therapeutic use; D018746:Systemic Inflammatory Response Syndrome / Q000150:complications* / Q000188:drug therapy; D016896:Treatment Outcome
chemical_list: D000890:Anti-Infective Agents; D004151:Dipeptides; D004187:Disaccharides; D005765:Gastrointestinal Agents; D054368:Laxatives; D012294:Rifamycins; D013402:Sugar Alcohols; D008795:Metronidazole; D007792:Lactulose; D000641:Ammonia; D009355:Neomycin; C002939:ornithylaspartate; C014635:lactitol; D000078262:Rifaximin