Branched Chain Amino Acids in the Treatment of Latent Portosystemic Encephalopathy

Egberts, E.‐H.; Schomerus, H; Hamster, W.; Jürgens, P.

doi:10.1016/s0016-5085(85)80004-4

Cited by 143 publications

(61 citation statements)

References 15 publications

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“…[15][16][17] Several treatment modalities that reduce ammonia level have been tried in order to treat this condition, for example, dietary protein manipulation, 18 branched-chain amino acids, 19 L-ornithine L-aspartate, 20 lactulose, 21,22,46 and probiotics. 23 Most of the studies of these treatment modalities have found improvement in psychometry, [19][20][21][22][23] ammonia level, 20,23,24 and cerebral edema. 46 We did not measure ammonia level in our patients; however, we believe that improvement in the MHE in our patients most likely was related to the same mechanism.…”

Section: Discussionmentioning

confidence: 99%

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Lactulose improves cognitive functions and health-related quality of life in patients with cirrhosis who have minimal hepatic encephalopathy

et al. 2007

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Minimal hepatic encephalopathy (MHE) has a negative effect on patients' daily functioning. Thus far, no study has investigated the effect of treatment-related improvement in cognitive functions on health-related quality of life (HRQOL). We measured psychometric performance by number and figure connection tests parts A and B, picture completion, and block design tests and HRQOL by the Sickness Impact Profile (SIP) of 90 patients with cirrhosis on inclusion into the study and 3 months later. A Z score less than ؊2 on the neuropsychological (NP) tests was considered abnormal. Sixty-one (67.7%) patients had MHE. They were randomly assigned in a 1:1 ratio to receive treatment (lactulose) for 3 months (n ‫؍‬ 31) or no treatment (n ‫؍‬ 30) in a nonblinded design. H epatic encephalopathy (HE) is a spectrum of neuropsychiatric abnormalities seen in patients with liver dysfunction diagnosed after exclusion of other known brain diseases. The Working Party at the 11th World Congress of Gastroenterology, Vienna, under the Organization Mondiale de Gastroentrologie proposed a multiaxial definition of HE that defined both the type of hepatic abnormality (type A, B, or C) and the duration and characteristics of neurological manifestations (episodic, persistent, or minimal HE) in chronic liver disease. 1 HE has been considered a continuous dimension that could be measured with 1 index to summarize several neurological domains, such as cognition, emotion, behavior, and biologic rhythms. Minimal hepatic encephalopathy (MHE) represents a portion of this dimension and is the mildest form of HE. Whereas patients with HE have impaired intellectual functioning, personality changes, altered level of consciousness, and neuromuscular dysfunction, patients with MHE have no recognizable clinical symptoms of HE but do have mild cognitive and psychomotor deficits. In the absence of a "gold standard" for determining MHE, neuropsychological (NP) and neurophysiological methods have been the most trusted and widely used tests to diagnose this condition. 1,2 MHE is considered clinically relevant for at least 3 reasons. First, it impairs patients' daily functioning and

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Section: Discussionmentioning

confidence: 99%

“…[15][16][17] Therapeutic interventions that aim to reduce ammonia are also useful in this setting. [18][19][20][21][22][23][24] Most studies have shown improvement in psychomotor functions coupled with a reduction in ammonia level. Improvement in cognitive functions may translate into improvement in HRQOL.…”

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confidence: 99%

Lactulose improves cognitive functions and health-related quality of life in patients with cirrhosis who have minimal hepatic encephalopathy

et al. 2007

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“…18 In view of the reported high prevalence of SHE and its presumed negative effect on daily life, routine screening of cirrhotic patients for SHE and treatment of SHE is recommended. [19][20][21] However, the need of treatment of SHE is questionable, because a recent study has shown that patients with SHE did not perform worse driving ''on the road'' than patients without SHE. 22 Driving a car is an important, but small, part of the total spectrum of daily activities.…”

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confidence: 99%

Subclinical hepatic encephalopathy impairs daily functioning

Groeneweg¹,

Quero²,

Bruijn³

et al. 1998

Hepatology

466

310

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Subclinical hepatic encephalopathy (SHE) is assumed to have a negative effect on patients' daily functioning; therefore, treatment is recommended. However, no studies have been performed that document the clinical relevance of SHE. We performed a study in which the prevalence of SHE was determined in 179 outpatients with cirrhosis using two psychometric tests (Number Connection Test Part A [NCT-A] and the Digit Symbol Test [DGT]) and automated analysis of the electroencephalogram (EEG). SHE was defined by the presence of at least one abnormal psychometric test and/or abnormal slowing of the EEG. The influence of cirrhosis and SHE on patients' daily functioning was assessed using the Sickness Impact Profile (SIP) questionnaire. The distribution of SIP scores of the patients with cirrhosis differed from the reference scores of the general population. Patients with cirrhosis and SHE (n ‫؍‬ 48) reported significantly more impairment in all 12 scales of the SIP, in the psychosocial subscore, the physical subscore, as well as in the total SIP score, compared with cirrhotic patients without SHE (n ‫؍‬ 131). Multivariate analysis taking into account severity of liver disease (Child-Pugh score), presence of varices, and alcoholic etiology, showed that SHE independently was related to a diminished total SIP score. The reproducibility of the SIP was high when the test was repeated after a 3-month period. We conclude that SHE implies impaired daily functioning and warrants attempts at treatment. (HEPATOLOGY 1998;28:45-49.)Clinical manifestations of hepatic encephalopathy include a decreased intellectual function, personality disorders, an altered level of consciousness, and neuromuscular dysfunction. 1 In addition to clinical manifest hepatic encephalopathy, 2 a subclinical stage has been described, which cannot be detected through global clinical examination, but requires specific neuropsychological and neurophysiological examination. [3][4][5][6][7][8][9][10][11][12] The prevalence of subclinical hepatic encephalopathy (SHE) is estimated to vary from 30% to 84% according to recent studies using appropriate methods. [12][13][14][15][16] This variation in reported prevalence depends on the kind (psychometric or electrophysiological) and number of tests used, and the population (etiology and severity of the liver disease) tested. 17

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“…BCAA seems to be the preferred substrate to meet this demand, because its energy efficacy is higher than that of glucose or fatty acids in patients with cirrhosis [4]. Additionally, BCAA supplement may be considered to provide the necessary nitrogen intake without detrimental effects on the mental state, perhaps even improving it [5][6][7]. Therefore, several commercial formulas with 30-50% of free BCAA have been developed for cirrhotic patients.…”

Section: Introductionmentioning

confidence: 99%

Nutritional and Clinical Evaluation of a Modified Soy Protein with Covalently Bound Branched-Chain Amino Acids in Cirrhotic Sprague-Dawley Rats

et al. 2003

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Several studies suggested that branched-chain amino acids (BCAA) improve plasma amino acid imbalance as well as protein metabolism in patients with cirrhosis. However, commercial formulas supplemented with free BCAA have their limitations. We evaluated a modified soy protein diet with covalently bound BCAA (diet M) by comparing it with diets based on casein (diet C) or Hepatic Aid II (diet H; commercial formula) as protein sources. After 3 weeks of bile duct obstruction, 24 Sprague-Dawley rats divided into three groups received diets with 9% (w/w) protein/amino acids for 7 days. Nutritional and clinical parameters were determined. Nitrogen balance and weight gain (g)/protein intake (g) with diet M (0.19 ± 0.31 and 1.33 ± 1.43 g, respectively) were significantly higher (p < 0.05) than with diet H (–0.34 ± 0.20 and –0.34 ± 1.11 g), but comparable to those with diet C (0.04 ± 0.38 and 0.20 ± 0.93 g). Animals on diet M had a significantly (p < 0.05) increased plasma BCAA:aromatic amino acid ratio (1.8 ± 0.3) as compared with those on diets H (1.3 ± 0.1) and C (0.8 ± 0.0). There were no significant differences in organ weight or liver function among the groups. We conclude that the BCAA-modified protein is an attractive option in the nutritional support of patients having cirrhosis.

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Branched Chain Amino Acids in the Treatment of Latent Portosystemic Encephalopathy

Cited by 143 publications

References 15 publications

Lactulose improves cognitive functions and health-related quality of life in patients with cirrhosis who have minimal hepatic encephalopathy

Lactulose improves cognitive functions and health-related quality of life in patients with cirrhosis who have minimal hepatic encephalopathy

Subclinical hepatic encephalopathy impairs daily functioning

Nutritional and Clinical Evaluation of a Modified Soy Protein with Covalently Bound Branched-Chain Amino Acids in Cirrhotic Sprague-Dawley Rats

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