Current approach to treatment of minimal hepatic encephalopathy in patients with liver cirrhosis

Morán, Segundo; López-Sánchez, Marlene; Milke-García, María del Pilar; Rodríguez-Leal, Gustavo Arturo

doi:10.3748/wjg.v27.i22.3050

Cited by 17 publications

(12 citation statements)

References 65 publications

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“…Lactulose is often used in MHE clinical treatment. The mechanism is that lactulose is not absorbed in the human intestine and concurrently decomposes and releases lactic acid and acetic acid, acidifying the intestinal tract and promoting colon peristalsis as well as content excretion, which can alleviate the disease to some extent but cannot completely cure it [13]. Thus, its therapeutic effect needs further improvement.…”

Section: Discussionmentioning

confidence: 99%

Clinical study of probiotics combined with lactulose for minimal hepatic encephalopathy treatment

Shi

2023

European Journal of Gastroenterology &Amp; Hepatology

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Objective This study aimed to investigate the clinical effect of probiotics combined with lactulose for minimal hepatic encephalopathy (MHE) treatment. Methods A total of 88 patients with MHE were randomly divided into the control (n = 44) and combined groups (n = 44). The control group was treated with lactulose, while the combined group was treated with probiotics and lactulose. Serum ammonia, liver function [alanine aminotransferase (ALT) and aspartate transaminase (AST)], intestinal mucosal barrier markers [fatty acid-binding protein 2 (FABP2) and advanced glycation end-products (AGEs)] and number connection test A (NCT-A) and digit symbol test (DST) scores were tested and compared between the two groups. Results The post-treatment in the control and combined groups shows decreased serum ammonia levels, ALT and AST levels, FABP2 and AGEs levels and NCT-A score and increased DST score compared with pre-treatment, with a significant difference (P < 0.05). Post-treatment, the serum ammonia level, ALT and AST levels, FABP2 and AGEs levels, NCT-A score decreased and DST score increased in the combined group compared with the control group, with a significant difference (P < 0.05). Conclusion Probiotics can promote lactulose in MHE treatment.

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Section: Discussionmentioning

confidence: 99%

Clinical study of probiotics combined with lactulose for minimal hepatic encephalopathy treatment

Shi

2023

European Journal of Gastroenterology &Amp; Hepatology

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“…In studies comparing probiotics with lactulose, better results were obtained in the NCT test in the lactulose treatment group compared to the probiotic treatment group. 23,24 In another study evaluating the efficacy of probiotics in the treatment of MHE, it was found that Clostridium butyricum and Bifidobacterium infantis were effective in improving MHE in patients with cirrhosis due to HBV. 25 In the prospective study conducted by Goyal et al 26 after 3 months of rifaximin and lactulose treatment of patients with MHE, a significant improvement was found in MHE.…”

Section: Discussionmentioning

confidence: 99%

Comparison of the Efficacy of Lactobacillus rhamnosus GG and Lactulose Treatments in Minimal Hepatic Encephalopathy

Gunel¹,

Barutçu²,

Yıldırım³

2022

Eur J Ther

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Objective: Minimal hepatic encephalopathy is a condition characterized by decreased perception and consequently deterioration in quality of life, and there is still limited data on its treatment. The aim of this study is to compare the efficacy of lactulose and Lactobacillus rhamnosus GG treatments by critical flicker frequency test in minimal hepatic encephalopathy patients. Methods: Patients with a critical flicker frequency test result of <39 Hz were considered to have minimal hepatic encephalopathy. Eighty-four minimal hepatic encephalopathy patients were divided into 3 groups as lactulose, Lactobacillus rhamnosus GG, and control group. Critical flicker frequency control was performed 4 weeks after treatment. Critical flicker frequency values before and after treatment were compared according to the treatment groups and evaluated. Results: Minimal hepatic encephalopathy was detected in 84 (54.5%) of 154 cirrhosis patients. Of the patients with minimal hepatic encephalopathy, 31 (36.9%) received lactulose, 31 (36.9%) Lactobacillus rhamnosus GG treatment, and 22 (26.2%) did not receive any treatment. In patients with minimal hepatic encephalopathy compared to those without minimal hepatic encephalopathy, there were statistically significant differences in terms of age (P = .003), body mass index (BMI) (P = .019), albumin (P < .001), sodium (P = .010), model for end-stage liver diseases score (P < .001), and Child Pugh Classification (CHILD) score (P < .001).There was no significant difference between cirrhosis etiology and treatment response (P = .535). Statistically significant increase was found in critical flicker frequency values in the lactulose (P = .011) and Lactobacillus rhamnosus GG (P = .007) groups after treatment. No statistically significant difference was found in the placebo group (P = .804). There was no statistically significant difference between lactulose and Lactobacillus rhamnosus GG (P = .576). Conclusion:In the treatment of minimal hepatic encephalopathy, Lactobacillus rhamnosus GG treatment is as effective like lactulose treatment and can be used safely.

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“…Rifaximin is an antibiotic that is minimally absorbed, has broad-spectrum activity against gram-positive and gram-negative aerobic and anaerobic enteric bacteria, and is clinically available for hepatic encephalopathy or travelers’ diarrhea[ 20 , 21 ]. Our recent clinical studies have elucidated that rifaximin significantly decreased serum endotoxin activity and potentially improved intestinal permeability without modifying the gut microbiome in patients with cirrhosis[ 22 ].…”

Section: Introductionmentioning

confidence: 99%

Dual therapy with zinc acetate and rifaximin prevents from ethanol-induced liver fibrosis by maintaining intestinal barrier integrity

Fujimoto¹,

Kaji²,

Nishimura³

et al. 2021

WJG

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BACKGROUND Hepatic overload of gut-derived lipopolysaccharide dictates the progression of alcoholic liver disease (ALD) by inducing oxidative stress and activating Kupffer cells and hepatic stellate cells through toll-like receptor 4 signaling. Therefore, targeting the maintenance of intestinal barrier integrity has attracted attention for the treatment of ALD. Zinc acetate and rifaximin, which is a nonabsorbable antibiotic, had been clinically used for patients with cirrhosis, particularly those with hepatic encephalopathy, and had been known to improve intestinal barrier dysfunction. However, only few studies focused on their efficacies in preventing the ALD-related fibrosis development. AIM To investigate the effects of a combined zinc acetate with rifaximin on liver fibrosis in a mouse ALD model. METHODS To induce ALD-related liver fibrosis, female C57BL/6J mice were fed a 2.5% (v/v) ethanol-containing Lieber-DeCarli liquid diet and received intraperitoneal carbon tetrachloride (CCl 4 ) injection twice weekly (1 mL/kg) for 8 wk. Zinc acetate (100 mg/L) and/or rifaximin (100 mg/L) were orally administered during experimental period. Hepatic steatosis, inflammation and fibrosis as well as intestinal barrier function were evaluated by histological and molecular analyses. Moreover, the direct effects of both agents on Caco-2 barrier function were assessed by in vitro assays. RESULTS In the ethanol plus CCl 4 -treated mice, combination of zinc acetate and rifaximin attenuated oxidative lipid peroxidation with downregulation of Nox2 and Nox4 . This combination significantly inhibited the Kupffer cells expansion and the proinflammatory response with blunted hepatic exposure of lipopolysaccharide and the toll-like receptor 4/nuclear factor kB pathway. Consequently, liver fibrosis and hepatic stellate cells activation were efficiently suppressed with downregulation of Mmp-2, -9, -13, and Timp1 . Both agents improved the atrophic changes and permeability in the ileum, with restoration of tight junction proteins (TJPs) by decreasing the expressions of tumor necrosis factor α and myosin light chain kinase. In the in vitro assay, both agents directly reinforced ethanol or lipopolysaccharide-stimulated paracellular permeability and upregulated TJPs in Caco-2 cells. CONCLUSION Dual therapy with zinc acetate and rifaximin may serve as a strategy to prevent ALD-related fibrosis by maintaining intestinal barrier integrity.

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Current approach to treatment of minimal hepatic encephalopathy in patients with liver cirrhosis

Cited by 17 publications

References 65 publications

Clinical study of probiotics combined with lactulose for minimal hepatic encephalopathy treatment

Clinical study of probiotics combined with lactulose for minimal hepatic encephalopathy treatment

Comparison of the Efficacy of Lactobacillus rhamnosus GG and Lactulose Treatments in Minimal Hepatic Encephalopathy

Dual therapy with zinc acetate and rifaximin prevents from ethanol-induced liver fibrosis by maintaining intestinal barrier integrity

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