Management of Hepatic Encephalopathy

Wright, Gavin; Chattree, Amit; Jalan, Rajiv

doi:10.4061/2011/841407

Cited by 24 publications

(18 citation statements)

References 88 publications

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“…Unfortunately, final PSG levels that may improve medically refractory ascites also increase the risk of hepatic encephalopathy (21,22). Although we found no independent predictors of hepatic encephalopathy, it should be noted that nearly all instances of hepatic encephalopathy were mild cases, graded at 0 or 1, which are generally treatable with dietary modification and medical therapy (23)(24)(25). Importantly, the occurrence of encephalopathy was not significantly associated with mortality in our cohort.…”

Section: Discussionmentioning

confidence: 41%

Transjugular intrahepatic portosystemic shunt for the treatment of medically refractory ascites

Parvinian¹,

Bui²,

Knuttinen³

et al. 2013

Diagn Interv Radiol

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ORIGINAL ARTICLE PURPOSE This study was performed to assess the safety, efficacy, and clinical outcomes of transjugular intrahepatic portosystemic shunt (TIPS) creation for treatment of medically refractory ascites and to identify prognostic factors for clinical response, morbidity, and mortality. MATERIALS AND METHODSIn this retrospective study, 80 patients (male:female, 52:28; mean age, 56 years; mean Model for End-Stage Liver Disease [MELD] score, 15.1) who underwent elective TIPS creation for refractory ascites between 1999-2012 were studied. A medical record review was performed to identify data on demographics, liver disease, procedures, and outcome. The influence of these parameters on 30-day, 90-day, and oneyear mortality was assessed using binary logistic regression. Overall survival was analyzed with Kaplan-Meier statistics. RESULTS TIPS was successfully created using covered (n=70) or bare metal (n=10) stents. Hemodynamic success was achieved in all cases. The mean final portosystemic pressure gradient (PSG) was 6.8 mmHg. Thirty-day complications included mild encephalopathy in 35% of patients. Clinical improvement in ascites occurred in 78% of patients, with complete resolution or a ≥50% decrease in 66% of patients. No predictors of response or optimal PSG threshold were identified. The 30-day, 90-day, and one-year mortality rates were 14%, 23%, and 33%, respectively. Patient age (P = 0.026) was associated with 30-day mortality, while final PSG was associated with 90-day (P = 0.020) and one year (P = 0.032) mortality. No predictors of overall survival were identified. CONCLUSION TIPS creation effectively treats medically refractory ascites with nearly 80% efficacy. The incidence of mild encephalopathy is nontrivial. Older age and final PSG are associated with mortality, and these factors should be considered in patient selection and procedure performance.T he development of medically refractory ascites is associated with a grave prognosis in patients with liver cirrhosis. One-year survival in this population is less than 50%, and there is an increased risk of complications such as spontaneous bacterial peritonitis, hepatorenal syndrome, and dilutional hyponatremia (1). Moreover, these patients typically have low Model for End-Stage Liver Disease (MELD) scores despite their high mortality rate, and thus hold low positions on national transplant listings (2, 3). Transjugular intrahepatic portosystemic shunt (TIPS) creation, an established treatment for complications of portal hypertension, has demonstrated utility in patients with refractory ascites (4). By diverting blood from the portal venous system to the systemic circulation, TIPS acts to lower hepatic sinusoidal pressure and increase effective circulatory flow, thereby reducing excess sodium retention and achieving ascites recurrence rates as low as 30% (5). Two recent studies revealed reduced mortality in patients undergoing TIPS placement, compared with those receiving serial large-volume paracentesis procedures, with one-year survival rates ra...

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Section: Discussionmentioning

confidence: 41%

Transjugular intrahepatic portosystemic shunt for the treatment of medically refractory ascites

Parvinian¹,

Bui²,

Knuttinen³

et al. 2013

Diagn Interv Radiol

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“…The effects of lactulose on blood ammonia and faecal pH in beagles with an end‐to‐side portacaval shunt have been studied by Wright et al . (). Concentrations of blood ammonia before and 2 weeks after the operation were 4.65 ± 0.34 μg mL −1 and 8.66 ± 0.60 μg mL −1 , respectively.…”

Section: Lactulose In Medical and Pharmaceutical Applicationsmentioning

confidence: 97%

“…Lactulose is hydrolysed by colonic bacteria and acts as promoting agent for their growth and increasing biomass formation. However, for the synthesis of bacterial protein, ammonia and nitrogen are used, but the production of ammonia is inhibited by acidifying the intestinal content (Wright et al, 2011). The effects of lactulose on blood ammonia and faecal pH in beagles with an end-to-side portacaval shunt have been studied by Wright et al (2011).…”

Section: Reducing Blood Ammonia Levelsmentioning

confidence: 99%

Lactulose: production and use in functional food, medical and pharmaceutical applications. Practical and critical review

Aït-Aissa

Aïder

2013

Int J of Food Sci Tech

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Summary Lactulose is a synthetic disaccharide. It can be obtained from lactose by chemical, enzymatic or by electro‐activation synthesis. This review provides the comprehension of lactulose production and its application in medical, pharmaceutical and functional food applications. Lactulose can be used in medical and pharmaceutical applications for the treatment of diseases such as chronic constipation, therapy of portal systemic encephalopathy, inflammatory bowel disease, reducing blood ammonia levels, colon carcinogenesis, tumour prevention and immunology, mineral absorption and for the inhibition of the secondary bile acid formation. However, with the growing interest in functional foods, the use of nondigestible oligosaccharides such as prebiotic ingredients has increased considerably during the recent years. In this context, lactulose as a well‐recognised prebiotic offers excellent possibilities to develop new functional foods. It can be added to several foods.

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“…Kronik karaciğer hastalıklarında, özellikle alkolik sirozlu hastalarda çinko eksikliği yaygındır. Hafif hepatik ensefalopatide çinko replasmanının düzeltici etkileri saptanmıştr (22).…”

Section: Fülminan Hepatit B Tedavisiunclassified

Management of Chronic Hepatitis in Special Hosts and Special Situations: A Consensus Report of the Study Group for Viral Hepatitis of the Turkish Society of Clinical Microbiology and Infectious Diseases

Mıstık¹,

Aydın²,

Aksoy³

et al. 2015

Klimik Dergisi

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ÖzetTürk Klinik Mikrobiyoloji ve İnfeksiyon Hastalıkları Derneği Viral Hepatit Çalışma Grubu, özel konaklarda ve özel durumlarda kronik hepatit yönetimine ilişkin bir uzlaşı raporu hazırlamak üzere bir toplantı düzenlemiştir. Raporda konuyla ilgili literatür ve uluslararası kılavuzlar, hepatit B virusu (HBV) için sırasıyla kompanse ve dekompanse sirozlu hastalarda kronik hepatit B (KHB) tedavisi, karaciğer nakli sonrası HBV infeksiyonunun nüks etmesinden korunma ve nüks gelişen hastalarda tedavi, fülminan hepatit B tedavisi, hemodiyaliz hastalarında KHB teda- AbstractStudy Group for Viral Hepatitis of the Turkish Society of Clinical Microbiology and Infectious Diseases convened a meeting to develop a consensus report on management of chronic hepatitis in special hosts and special situations. Relevant literature and international guidelines were reviewed, and recommendations agreed are presented at the end of each section such as therapy of chronic hepatitis B (CHB) in patients with compensated and decompensated cirrhosis, prevention and therapy of recurrent hepatitis B after liver transplantation, management of fulminant

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Management of Hepatic Encephalopathy

Cited by 24 publications

References 88 publications

Transjugular intrahepatic portosystemic shunt for the treatment of medically refractory ascites

Transjugular intrahepatic portosystemic shunt for the treatment of medically refractory ascites

Lactulose: production and use in functional food, medical and pharmaceutical applications. Practical and critical review

Management of Chronic Hepatitis in Special Hosts and Special Situations: A Consensus Report of the Study Group for Viral Hepatitis of the Turkish Society of Clinical Microbiology and Infectious Diseases

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