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hepatic encephalopathy lactulose

Mamatha Bhat, Bianca M Arendt, Venkat Bhat, Eberhard L Renner, Atul Humar, Johane P Allard
The intestinal microbiome (IM) is altered in patients with cirrhosis, and emerging literature suggests that this impacts on the development of complications. The PubMed database was searched from January 2000 to May 2015 for studies and review articles on the composition, pathophysiologic effects and therapeutic modulation of the IM in cirrhosis. The following combination of relevant text words and MeSH terms were used, namely intestinal microbiome, microbiota, or dysbiosis, and cirrhosis, encephalopathy, spontaneous bacterial peritonitis, hepatorenal syndrome, variceal bleeding, hepatopulmonary syndrome, portopulmonary hypertension and hepatocellular carcinoma...
September 28, 2016: World Journal of Hepatology
Liane Rabinowich, Julia Wendon, William Bernal, Oren Shibolet
AIM: To assess the practice of caring for acute liver failure (ALF) patients in varying geographic locations and medical centers. METHODS: Members of the European Acute Liver Failure Consortium completed an 88-item questionnaire detailing management of ALF. Responses from 22 transplantation centers in 11 countries were analyzed, treating between 300 and 500 ALF cases and performing over 100 liver transplants (LT) for ALF annually. The questions pertained to details of the institution and their clinical activity, standards of care, referral and admission, ward- based care versus intensive care unit (ICU) as well as questions regarding liver transplantation - including criteria, limitations, and perceived performance...
September 7, 2016: World Journal of Gastroenterology: WJG
Sarah E Petite
No abstract text is available yet for this article.
September 19, 2016: Journal of Pharmacy Practice
Nasser Mousa, Ahmed Abdel-Razik, Ashraf Zaher, Magdy Hamed, Gamal Shiha, Narmin Effat, Sherif Elbaz, Rania Elhelaly, Mohamed Hafez, Niveen El-Wakeel, Waleed Eldars
BACKGROUND: Minimal hepatic encephalopathy (MHE) has a far-reaching impact on quality and function ability in daily life and may progress to overt hepatic encephalopathy. There is a synergistic effect between systemic oxidative stress and ammonia that is implicated in the pathogenesis of hepatic encephalopathy. The aim of this study is to investigate the effectiveness of oral supplementation of antioxidants and zinc gluconate on MHE versus lactulose. METHODS: Our study included 58 patients with cirrhosis diagnosed as having MHE by neuropsychometric tests, including number connection test part A (NCT-A), digit symbol test (DST) and block design tests (BDTs)...
September 2016: Therapeutic Advances in Gastroenterology
Davide Festi, Giovanni Marasco, Federico Ravaioli, Antonio Colecchia
Hepatic encephalopathy (HE) is a common complication of liver cirrhosis and it can manifest with a broad spectrum of neuropsychiatric abnormalities of varying severity, acuity and time course with important clinical implications. According to recent guidelines, HE has been classified into different types, depending on the severity of hepatic dysfunction, the presence of porto-systemic shunts and the number of previous episodes or persistent manifestations. From a clinical point of view, HE can be recognized as unimpaired, covert (that deals with minimal and grade 1 according to the grading of mental state), and overt (that is categorized from grade 2 to grade 4)...
July 2016: Recenti Progressi in Medicina
Dominic Kaddu-Mulindwa, Frank Lammert, Alexander Maßmann, Andreas Link
HISTORY AND ADMISSION FINDINGS: A 23-year old female patient is referred to our intensive care unit from another hospital because of progredient neurological deterioration with sopor. One week before, she had experienced non-specific pain in her upper right stomach combined with vomitus and nausea. For two days, she had been treated with ciprofloxacin 2 × 500 mg / d by her primary care physician. Except for appendectomy in childhood, no other diseases were reported. Clinical investigation: Physical examination reveals mild scleral and dermal jaundice...
August 2016: Deutsche Medizinische Wochenschrift
Peter Jepsen, Jakob Christensen, Karin Weissenborn, Hugh Watson, Hendrik Vilstrup
BACKGROUND: Epilepsy is associated with an increased mortality among cirrhosis patients, but the reasons are unknown. We aimed to determine whether epilepsy is a risk factor for developing hepatic encephalopathy (HE), which is a strong predictor of mortality. METHODS: We used data from three randomized 1-year trials of satavaptan in cirrhosis patients with ascites. With Cox regression, we compared the hazard rates of HE grade 1-4 between those cirrhosis patients who did or did not have epilepsy...
2016: BMC Gastroenterology
Alba Moratalla, Javier Ampuero, Pablo Bellot, Rocío Gallego-Durán, Pedro Zapater, Manuela Roger, Blanca Figueruela, Belén Martínez-Moreno, José M González-Navajas, José Such, Manuel Romero-Gómez, Rubén Francés
BACKGROUND&AIM: Minimal hepatic encephalopathy is associated with poor prognosis and mortality in patients with cirrhosis. We aimed at investigating whether bacterial-DNA translocation affects hyperammonemia and neurocognitive scores in patients with mHE according to the use of lactulose. METHODS: Observational study including 72 mHE cirrhotic patients, as defined by a psychometric hepatic encephalopathy score (PHES)<-4 and/or a Critical Flicker Frequency (CFF)<39Hz...
July 7, 2016: Liver International: Official Journal of the International Association for the Study of the Liver
Anastasiia Kabeshova, Soumaia Ben Hariz, Elyonore Tsakeu, Robert Benamouzig, Robert Launois
BACKGROUND: Hepatic encephalopathy (HE) is a complex neuropsychiatric syndrome that occurs most often in a context of acute or chronic liver disease. Despite the seriousness of the pathology, only a few treatments have been developed for improving its management. Rifaximin-α is the first treatment that has been clinically developed for overt HE (OHE) episodes. Recent results of clinical studies demonstrated its significant improvement in the health-related quality of life. The objective of the current study was to estimate the long-term cost-effectiveness of rifaximin-α used in combination with lactulose compared with lactulose monotherapy in cirrhotic patients, who have experienced at least two prior OHE events...
July 2016: Therapeutic Advances in Gastroenterology
Felipe Toyama Aires, Paola Teruya Ramos, Wanderley Marques Bernardo
INTRODUCTION: Hepatic encephalopathy (HE) is a bad prognostic factor in patients with liver cirrhosis and its incidence is associated with several triggering factors being the most prevalent gastrointestinal bleeding. Lactulose, despite its questionable efficacy in the literature, is considered a first line treatment in patients with HE. OBJECTIVE: To evaluate the effectiveness of lactulose in preventing HE in cirrhotic patients with gastrointestinal bleeding. METHOD: A systematic review of the literature using the Medline scientific database...
May 2016: Revista da Associação Médica Brasileira
Supannee Rassameehiran, Charoen Mankongpaisarnrung, Grerk Sutamtewagul, Saranapoom Klomjit, Ariwan Rakvit
OBJECTIVES: The purpose of our study was to identify clinical parameters associated with readmissions within 90 days in patients with hepatic encephalopathy (HE). METHODS: We reviewed electronic medical records of patients admitted between January 1, 2010 and September 30, 2013 at University Medical Center, Lubbock, Texas. Inclusion criteria were admission to the hospital with diagnosis of HE in patients older than 18 years. We compared the patients with readmission within 90 days with patients with no readmission using routine clinical data...
June 2016: Southern Medical Journal
Meghan NeSmith, Joseph Ahn, Steven L Flamm
Hepatic encephalopathy (HE) is a major complication of liver disease that leads to significant morbidity and mortality. Caring for hospitalized patients with HE is becoming more complex, and the economic burden of HE continues to rise. Defining and diagnosing HE, particularly covert HE (CHE), remain challenging. In this article, we review new tools and those currently under development for the diagnosis of CHE and the latest advances in the acute and long-term management of overt HE (OHE) and CHE. In particular, we review the latest data on the use of lactulose and rifaximin for treatment of OHE and summarize the data on adjunctive agents such as sodium benzoate and probiotics...
February 2016: Gastroenterology & Hepatology
Lise Lotte Gluud, Hendrik Vilstrup, Marsha Y Morgan
BACKGROUND: Non-absorbable disaccharides (lactulose and lactitol) are recommended as first-line treatment for hepatic encephalopathy. The previous (second) version of this review included 10 randomised clinical trials (RCTs) evaluating non-absorbable disaccharides versus placebo/no intervention and eight RCTs evaluating lactulose versus lactitol for people with cirrhosis and hepatic encephalopathy. The review found no evidence to either support or refute the use of the non-absorbable disaccharides and no differences between lactulose versus lactitol...
2016: Cochrane Database of Systematic Reviews
Lise Lotte Gluud, Hendrik Vilstrup, Marsha Y Morgan
BACKGROUND: Non-absorbable disaccharides (lactulose and lactitol) are recommended as first-line treatment for hepatic encephalopathy. The previous (second) version of this review included 10 randomised clinical trials (RCTs) evaluating non-absorbable disaccharides versus placebo/no intervention and eight RCTs evaluating lactulose versus lactitol for people with cirrhosis and hepatic encephalopathy. The review found no evidence to either support or refute the use of the non-absorbable disaccharides and no differences between lactulose versus lactitol...
2016: Cochrane Database of Systematic Reviews
Lise L Gluud, Hendrik Vilstrup, Marsha Y Morgan
UNLABELLED: Nonabsorbable disaccharides (NADs) have been used to treat hepatic encephalopathy (HE) since 1966. However, a Cochrane Review, published in 2004, found insufficient evidence to recommend their use in this context. This updated systematic review evaluates the effects of the NADs, lactulose and lactitol, for the treatment and prevention of HE in patients with cirrhosis. Thirty-eight randomized controlled trials, involving 1,828 patients, were identified through electronic and manual searches; 31 randomized controlled trials looked at the treatment of HE, while seven looked at its primary/secondary prevention...
September 2016: Hepatology: Official Journal of the American Association for the Study of Liver Diseases
Jonathan A Lidbury, Audrey K Cook, Jörg M Steiner
OBJECTIVE: To comparatively review the pathogenesis, clinical presentation, diagnosis, and management of hepatic encephalopathy (HE) in dogs and cats. DATA SOURCES: The Medline database was searched for articles related to HE in people, dogs, and cats. Articles published within the last 5 years were given special importance. HUMAN DATA SYNTHESIS: The pathogenesis of HE is complex and incompletely understood, but ammonia appears to play a central role...
July 2016: Journal of Veterinary Emergency and Critical Care
Staffan Wahlin
Hepatic encephalopathy causes significant impairment and morbidity. Hepatic encephalopathy is just one of many causes for altered mental status in patients with cirrhosis of the liver. The initial management at admission to hospital includes a search for differential diagnoses and precipitating factors. A structured description of the type, cause, time course and clinical severity is essential for achieving medically safe communication and care of the HE patient. Lactulose and correction of any precipitating factors is the basis for initial therapy...
2016: Läkartidningen
Christian Schulz, Kerstin Schütte, Siegfried Kropf, Friedhelm C Schmitt, Riccardo Vasapolli, Leon M Kliegis, Antonia Riegger, Peter Malfertheiner
BACKGROUND: Hepatic encephalopathy (HE) is a clinically significant complication of liver cirrhosis impacting on the patients' quality of life. Minimal hepatic encephalopathy (MHE) is diagnosed by psychometric tests, found in up to 80 % of patients with liver cirrhosis and carries a high risk of progression to overt HE. Continuous therapy with rifaximin in combination with lactulose significantly reduces the risk of overt HE, recurrence of HE and HE-related hospitalizations in randomized, double-blind, placebo-controlled clinical trials...
2016: Trials
Aniket N Tavare, Diane Murray
A 35-year-old man presented with acute alcoholic hepatitis and encephalopathy. He was hyponatremic, with a sodium level of 119 mmol per liter. Over the next 5 days his clinical condition improved with supportive treatment, which included lactulose and intravenous vitamins and the careful..
February 18, 2016: New England Journal of Medicine
Robert S Rahimi, Don C Rockey
Hepatic encephalopathy (HE) is a major complication in patients with decompensated cirrhosis, leading to higher readmission rates causing a profound burden of disease and considerable health care costs. Because ammonia is thought to play a crucial role in the pathogenesis of HE, therapies directed at reducing ammonia levels are now being aggressively developed. Ammonia scavengers such as AST-120 (spherical carbon adsorbent), glycerol phenylbutyrate, sodium phenylacetate or sodium benzoate, and ornithine phenylacetate have been used to improve HE symptoms...
February 2016: Seminars in Liver Disease
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