Prevention of post-tips hepatic encephalopathy: The search of the ideal candidate

Nardelli, Silvia; Bellafante, Daniele; Faccioli, Jessica; Riggio, Oliviero; Gioia, Stefania

doi:10.1007/s11011-022-01131-0

Cited by 10 publications

(7 citation statements)

References 79 publications

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“…One of the major complications of TIPS is post-TIPS HE [83]. The incidence of new or worsening HE after TIPS placement is 35-50% [84][85][86], and the risk of refractory HE after TIPS is 8% [87]. Nowadays, there is little evidence for the existence of an effective pharmacological treatment to prevent the onset of post-TIPS HE.…”

Section: Transjugular Intrahepatic Portosystemic Shunt (Tips)mentioning

confidence: 99%

Old and New Precipitants in Hepatic Encephalopathy: A New Look at a Field in Continuous Evolution

Bellafante

Gioia

Faccioli

et al. 2023

JCM

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Hepatic encephalopathy (HE) is a common complication in patients with advanced liver disease. It is a brain dysfunction characterized by neurological and psychiatric symptoms that significantly affects quality of life, morbidity and mortality of patients. HE has various precipitants that can potentially promote its onset, alone or in combination. Among the historically well-known precipitants, such as infections, gastrointestinal bleeding, dehydration, electrolyte disorders and constipation, recent studies have highlighted the role of malnutrition and portosystemic shunts as new precipitating factors of HE. The identification, management and correction of these factors are fundamental for effective HE treatment, in addition to pharmacological therapy with non-absorbable disaccharides and/or antibiotics.

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Section: Transjugular Intrahepatic Portosystemic Shunt (Tips)mentioning

confidence: 99%

Old and New Precipitants in Hepatic Encephalopathy: A New Look at a Field in Continuous Evolution

Bellafante

Gioia

Faccioli

et al. 2023

JCM

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“…The size, total cross-sectional area (TSA) and morphology of spontaneous portosystemic shunts (SPSSs) are associated with the development of HE; in fact, according to recent studies, it was suggested that an SPSS larger than 1 cm, a TSA > 83 mm 2 and splenorenal shunt are more associated than others with the development of persistent or recurrent HE [ 42 , 43 ]. Regarding TIPSs, the incidence of HE after a TIPS placement is around 35–50% [ 44 , 45 ], depending on the stent diameter used [ 46 ]. A recent RCT by Wang Q. et al compared the incidence of post-TIPS overt HE in patients that received an 8 mm covered stent implantation vs. patients that received a 10 mm covered stent implantation.…”

Section: Management Of Overt He In Hospitalized Patientsmentioning

confidence: 99%

The Management of Hepatic Encephalopathy from Ward to Domiciliary Care: Current Evidence and Gray Areas

Bellafante,

Gioia,

Faccioli

et al. 2023

JCM

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Hepatic encephalopathy (HE) is a common complication of advanced liver disease and acute liver failure. It is a condition that features several neuropsychiatric symptoms that affect mortality, morbidity and the quality of patients’ and caregivers’ lives. An HE diagnosis is generally an exclusion diagnosis. Once the patient is admitted to the hospital, clinical examination, blood tests and eventually neuroimaging should be performed with the aim of ruling out other causes of acute brain dysfunction. Moreover, HE is recognized using various precipitants that can potentially promote its onset, alone or in combination, and must be identified. Once the diagnostic process is complete, a correct treatment should be started. The anti-HE treatment is based on a combination of the correction of precipitants; non-absorbable antibiotics, such as rifaximin; and non-absorbable disaccharides. Once the patient is discharged from the hospital, specific anti-HE therapy should be maintained in order to prevent other HE episodes.

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“…Therefore, patient selection for TIPS requires careful assessment of risk factors for HE [34][35][36]. The search for the ideal candidate should take into account multiple parameters such as the history of HE and the presence of minimal HE, the comorbidities and age of the patient, liver and renal function, as well as the presence of alterations of nutritional status (i.e., sarcopenia and myosteatosis) [37].…”

Section: Effects Of Tips On Nutritional Status In Cirrhosis and Possi...mentioning

confidence: 99%

Transjugular Intrahepatic Portosystemic Shunt Placement: Effects on Nutritional Status in Cirrhotic Patients

de Felice,

Ridola,

Riggio

et al. 2023

JCM

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Malnutrition is a tangible complication of cirrhosis with portal hypertension with a prevalence of up to 50%. In particular, sarcopenia and myosteatosis, defined as the alteration in muscle quantity and quality, have a negative impact on the main complications of liver disease and are associated with higher mortality in patients with cirrhosis. Recently, alterations in adipose tissue have also been described in cirrhotic patients and they seem to influence the course of liver disease. Several pieces of evidence indicate that a transjugular intrahepatic portosystemic shunt (TIPS), placed for the treatment of refractory portal hypertension, can lead to a modification of body composition consisting in the improvement of the skeletal muscle index, myosteatosis, and an increase in subcutaneous fat. These modifications of the nutritional status, even more pronounced in sarcopenic patients before TIPS, have been associated with an amelioration of cognitive impairment after TIPS as well as with an increase in the survival rate. The aim of this paper is to provide an overview of the effects of TIPS placement on nutritional status in cirrhosis focusing on its pathophysiological mechanisms and its relationship with liver-related outcomes.

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Prevention of post-tips hepatic encephalopathy: The search of the ideal candidate

Cited by 10 publications

References 79 publications

Old and New Precipitants in Hepatic Encephalopathy: A New Look at a Field in Continuous Evolution

Old and New Precipitants in Hepatic Encephalopathy: A New Look at a Field in Continuous Evolution

The Management of Hepatic Encephalopathy from Ward to Domiciliary Care: Current Evidence and Gray Areas

Transjugular Intrahepatic Portosystemic Shunt Placement: Effects on Nutritional Status in Cirrhotic Patients

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