Normal protein diet for episodic hepatic encephalopathy: results of a randomized study

Córdoba, Juan; López-Hellı́n, Joan; Planas, M.; Sabı́n, Pilar; Sanpedro, Francesc; Castro, Francisco; Esteban, Rafael; Guardia, J.

doi:10.1016/j.jhep.2004.03.023

Cited by 398 publications

(215 citation statements)

References 26 publications

(37 reference statements)

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“…The latter is metabolically more adequate and tolerable for cirrhotic patients with episodic hepatic encephalopathy [196]. Restriction of the protein content in the diet does not confer any benefit to patients during an episode of encephalopathy [197].…”

Section: Cq: Is Albumin Infusion Effective For Treatment Of Cirrhoticmentioning

confidence: 99%

Evidence-based clinical practice guidelines for liver cirrhosis 2015

et al. 2016

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The Japanese Society of Gastroenterology revised the evidence-based clinical practice guidelines for liver cirrhosis in 2015. Eighty-three clinical questions were selected, and a literature search was performed for the clinical questions with use of the MEDLINE, Cochrane, and Igaku Chuo Zasshi databases for the period between 1983 and June 2012. Manual searching of the latest important literature was added until August 2015. The guidelines were developed with use of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. This digest version in English introduces selected clinical questions and statements related to the management of liver cirrhosis and its complications. Branched-chain amino acids relieve hypoalbuminemia and hepatic encephalopathy and improve quality of life. Nucleoside analogues and peginterferon plus ribavirin combination therapy improve the prognosis of patients with hepatitis B virus related liver cirrhosis and hepatitis C related compensated liver cirrhosis, respectively, although the latter therapy may be replaced by direct-acting antivirals. For liver cirrhosis caused by primary biliary cirrhosis and active autoimmune hepatitis, urosodeoxycholic acid and steroid are recommended, respectively. The most adequate modalities for the management of variceal bleeding are the endoscopic injection sclerotherapy for esophageal varices and the balloon-occluded retrograde transvenous obliteration following endoscopic obturation with cyanoacrylate for gastric varices. Beta-blockers are useful for primary prophylaxis of esophageal variceal bleeding. The V 2 receptor antagonist tolvaptan is a useful add-on therapy in careful diuretic therapy for ascites. Albumin infusion is useful for the prevention of paracentesis-induced circulatory disturbance and renal failure. In addition to disaccharides, the nonabsorbable antibiotic rifaximin is useful for the management of encephalopathy. Anticoagulation therapy is proposed for patients with acute-onset or progressive portal vein thrombosis.

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Section: Cq: Is Albumin Infusion Effective For Treatment Of Cirrhoticmentioning

confidence: 99%

Evidence-based clinical practice guidelines for liver cirrhosis 2015

et al. 2016

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“…For 20-60% of patients with liver diseases nutritional insufficiency was diagnosed (19). Particular attention was paid on protein insufficiency, which can occur in different stages of liver diseases, though more often in later ones.…”

Section: Diet Recommendations For Patients With Hementioning

confidence: 99%

Diagnosis and treatment of hepatic encephalopathy

Savlan¹,

Liakina²,

Valantinas³

2013

AML

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Background. Hepatic encephalopathy (HE) is a neuropsychiatric complication of liver cirrhosis which symptoms may vary from imperceptible to severe ones. In recent years, there have been some changes of fundamental hepatic encephalopathy pathogenesis and treatment. The early HE on the stage of minimal hepatic encephalopathy (MHE) is rarely diagnosed and treatable condition worldwide and in Lithuania as well, however, this HE stage is responsible for the cognitive disorders which impair the quality of life of cirrhotic patients. According to resent data, MHE can be diagnosed in up to 70% of cirrhotic patients.Aim. To evaluate new diagnostic and treatment strategies for HE and especially MHE for further use in clinical practice to cure the quality of life of cirrhotic patients and prevent clinical manifestation of HE.Methods and materials. This article is based on relevant original publications and reviews in English (1991English ( -2012 that were retrieved by a selective key word based search in the Medline and PubMed databases.Results. It is recommended not to decrease an amount of proteins in food and consume products containing more branched-chain amino acids. Non-absorbable disaccharides (lactulose) are still the drugs of the first choice, though recent data show significant concerns about their effectiveness. Rifaximin is increasingly used all over the world for hepatic encephalopathy treatment. Other drugs for HE treatment are of secondary importance. Lactulose, probiotics are recommended for minimal hepatic encephalopathy treatment.Diagnosis, especially of minimal hepatic encephalopathy, remains complicated. There are no reliable and validated blood indicators to establish minimal hepatic encephalopathy diagnosis, and to follow up treatment efficacy. Psychometric and neurophysiologic methods, visualisation methods are used more in scientific researches. Computerized methods, such as inhibitory control and critical flicker frequency tests, are also promising.Conclusions. Further studies are necessary to design proper algorithms of hepatic encephalopathy diagnostic and treatment.

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“…Even in patients with acute hepatic encephalopathy, a normal protein intake has been shown not to be harmful and able to avoid the increase in protein breakdown. 49 In malnourished patients, a dietary interview can be helpful to evaluate whether the intake is sufficient to meet the patient's requirements and to adopt an adequate nutritional counseling. It is highly recommended to make the periods of starvation shorter, by dividing the daily energy intake in multiple meals during the day.…”

Section: Indications For Malnourished Patients Waiting For Liver Tranmentioning

confidence: 99%

Nutritional Status and Liver Transplantation

Merli¹,

Giusto²,

Giannelli³

et al. 2011

Journal of Clinical and Experimental Hepatology

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Chronic liver disease has a profound effect on nutritional status and undernourishment is almost universally present in patients with end-stage liver disease undergoing liver transplantation. In the last decades, due to epidemiological changes, a trend showing an increase in patients with end-stage liver disease and associated obesity has also been reported in developed countries. Nutrition abnormalities may influence the outcome after transplantation therefore, the importance to carefully assess the nutritional status in the work-up of patients candidates for liver transplantation is widely accepted. More attention has been given to malnourished patients as they represent the greater number. The subjective global nutritional assessment and anthropometric measurements are recognized in current guidelines to be adequate in identifying those patients at risk of malnutrition. Cirrhotic patients with a depletion in lean body mass and fat deposits have an increased surgical risk and malnutrition may impact on morbidity, mortality and costs in the post-transplantation setting. For this reason an adequate calorie and protein intake should always be ensured to malnourished cirrhotic patient either through the diet, or using oral nutritional supplements or by enteral or parenteral nutrition although studies supporting the efficacy of nutritional supplementation in improving the clinical outcomes after transplantation are still scarce. When liver function is restored, an amelioration in the nutritional status is expected. After liver transplantation in fact dietary intake rapidly normalizes and fat mass is progressively regained while the recovery of muscle mass can be slower. In some patients unregulated weight gain may lead to over-nutrition and may favor metabolic disorders (hypertension, hyperglycemia, hyperlipidemia). This condition, defined as 'metabolic syndrome', may play a negative role on the overall survival of liver transplant patients. In this report we review data on nutrition and liver transplantation. © 2011 INASL

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Normal protein diet for episodic hepatic encephalopathy: results of a randomized study

Cited by 398 publications

References 26 publications

Evidence-based clinical practice guidelines for liver cirrhosis 2015

Evidence-based clinical practice guidelines for liver cirrhosis 2015

Diagnosis and treatment of hepatic encephalopathy

Nutritional Status and Liver Transplantation

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