title: A systematic review and meta-analysis of the use of oral zinc in the treatment of hepatic encephalopathy.
abstract: OBJECTIVE
  Because low serum zinc levels precipitate hepatic encephalopathy, zinc supplementation is considered a potential therapeutic option. The aim of this study was to assess the effects of oral zinc supplementation in the treatment of hepatic encephalopathy.
  
  
  METHODS
  For this systematic review and meta-analysis, data sources included electronic databases (CENTRAL, MEDLINE, EMBASE) and manual searching. Randomized clinical trials of adult patients diagnosed with liver cirrhosis and hepatic encephalopathy were included. The types of interventions considered were any oral zinc supplementation versus no intervention, placebo, or other interventions for the management of hepatic encephalopathy. The data were analyzed by calculating the RR for each trial and expressing the uncertainty as 95% CI. Continuous data were analyzed by calculating the standard mean differences (SMD) between groups within each trial and their 95% CI. Statistical heterogeneity was defined as a P-value > 0.10 (χ2) or I2 > 25%.
  
  
  RESULTS
  Four trials with a total of 233 patients were included. Oral zinc supplementation was associated with a significant improvement in performance on the number connection test (SMD -0.62; 95% CI -1.12 to -0.11) reported in three trials (n = 189), but not with encephalopathy recurrence reduction (RR 0.64; 95% CI 0.26 to 1.59) reported in two trials (n = 169). Other clinically significant outcomes (mortality, liver related morbidity, quality of life) were not reported.
  
  
  CONCLUSIONS
  Oral zinc supplementation improved performance on the number connection test, but no evidence about other clinical or biochemical outcomes was available.
authors.affiliation: Obesity and Digestive Diseases Unit, Medica Sur Clinic & Foundation, Mexico City, Mexico. khavez@gmail.com
authors.forename: Norberto C
authors.initials: NC
authors.lastname: Chavez-Tapia
authors.forename: Asunción
authors.initials: A
authors.lastname: Cesar-Arce
authors.forename: Tonatiuh
authors.initials: T
authors.lastname: Barrientos-Gutiérrez
authors.forename: Francisco A
authors.initials: FA
authors.lastname: Villegas-López
authors.forename: Nahum
authors.initials: N
authors.lastname: Méndez-Sanchez
authors.forename: Misael
authors.initials: M
authors.lastname: Uribe
mesh_terms: D000284:Administration, Oral; D019317:Evidence-Based Medicine; D006501:Hepatic Encephalopathy / Q000188:drug therapy*; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome; D015032:Zinc / Q000008:administration & dosage*
chemical_list: D015032:Zinc