Branched Chain Amino Acid Enriched Solutions in the Treatment of Hepatic Encephalopathy: A Controlled Trial

Fiaccadori, F; Ghinelli, F; Pedretti, Giorgio; Pelosi, Giorgio; Sacchini, D.; Zeneroli, Maria Luisa; Rocchi, Emilio; Gibertini, P; Ventura, Ezio

doi:10.1007/978-1-4684-4787-3_33

Cited by 30 publications

(8 citation statements)

References 7 publications

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“…The specific result of this study-that of improved responsiveness in patients treated with a modified amino acid metabolic support solution-is consistent with several other recently completed randomized prospective studies comparing the efficacy of infused BCAA solutions with hypertonic dextrose as a caloric source us standard therapy in the treatment of hepatic encephalopathy. In these trials either the same or similar amino acid formulas were used by either the enteraP4-16 or parenteral', 12,17 route. In one of these trials,&dquo; survival was increased in patients receiving parenteral amino acid formulations.…”

Section: Discussionmentioning

confidence: 99%

Disease‐Specific Amino Acid Infusion (F080) in Hepatic Encephalopathy: A Prospective, Randomized, Double‐Blind, Controlled Trial

Cerra

Cheung

Fischer

et al. 1985

J Parenter Enteral Nutr

173

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Seventy-five patients with acute hepatic decompensation superimposed on chronic alcoholic cirrhosis were prospectively randomized for a blinded trial of the treatment of hepatic encephalopathy. The control group received 4 g of enteral neomycin daily along with 25% dextrose by a central venous catheter. The experimental group received a placebo resembling neomycin and isocaloric dextrose plus a modified amino acid mixture enriched with branched-chain amino acids to 36% and deficient in aromatic amino acids and methionine. Thirty patients in the F080 group and 29 in the control group completed the trial. The group receiving the modified amino acid mixture demonstrated a statistically significant improvement in encephalopathy as compared to the neomycin group, while maintaining nitrogen equilibrium. Survival and discharge from the hospital were statistically greater in the group treated with the modified amino acid solution and hypertonic dextrose. Treatment of hepatic encephalopathy in the presence of hepatic decompensation with an amino acid solution formulated for its treatment seems to produce faster, more complete recovery with improved capacity for nutritional support.

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Section: Discussionmentioning

confidence: 99%

Disease‐Specific Amino Acid Infusion (F080) in Hepatic Encephalopathy: A Prospective, Randomized, Double‐Blind, Controlled Trial

Cerra

Cheung

Fischer

et al. 1985

J Parenter Enteral Nutr

173

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show abstract

“…Seven controlled studies have been published on i.v. BCAA treatment 2–8 . Most were addressed to patients with severe hepatic encephalopathy, frequently due to variceal bleeding, admitted to hospital in emergency and treated for only a few days (2–6 days) and a relatively brief post‐treatment observation period (4–16 days).…”

Section: IV Bcaa and Cirrhosis With Acute Encephalopathymentioning

confidence: 99%

Nutritional therapy in cirrhosis

Marchesini¹,

Marzocchi²,

Agostini³

et al. 2004

J of Gastro and Hepatol

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In recent years increasing interest has been given to nutritional therapy in a variety of chronic diseases, including cirrhosis. Protein/calorie malnutrition is a common feature of advanced liver disease, and considerably affects prognosis. Hence, the need for nutritional support to provide patients with the minimum protein requirements to balance increased catabolism. Although most patients tolerate normal protein supply, in subjects with impending encephalopathy a nutritional support with branched-chain amino acids (BCAA) was suggested on the basis of neuro-pharmacological studies. A large, randomized trial has recently provided evidence that BCAA may be superior to equicaloric and equinitrogenous supplements, improving survival and retarding hepatocellular failure. Administration schedules including a late evening supplementation may be particularly helpful. Biochemical studies are providing the rationale for the beneficial effects, showing that leucine may be an important regulator of amino acid/protein metabolism.

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“…Naylor et al 21 conducted a meta-analysis that included 9 clinical studies 14,15,18,[23][24][25][26][27][28] to evaluate the role of IV BCAAs on mental recovery and survival of patients with acute HE. The meta-analysis included 6 completed randomized controlled studies, 14,15,18,23,27,28 2 randomized controlled studies in abstract format, 25,26 and 1 study that did not have a randomized controlled design. 24 Using different ways of data aggregation, the authors concluded that IV BCAA formulas significantly improve recovery from HE and perhaps reduce mortality.…”

Section: Bcaas and Hementioning

confidence: 99%

“…As stated in the review, 22 data from the 2 studies that compared BCAAs with glucose 15,35 and from the 1 study that compared BCAAs with standard amino acids 17 showed no statistically significant difference on HE and mortality between the treatment and control groups. None of the 4 studies that compared BCAAs with either lactulose 14,16 or neomycin 18,19 reported significant differences in improvement of HE or mortality. As such, the reviewers concluded that "BCAA therapy, whether pure or combined with other amino acids, irrespective of the amount administered, does not appear to affect significantly the outcome of patients with acute HE."…”

Section: Bcaas and Hementioning

confidence: 99%