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Lactulose, rifaximin or branched chain amino acids for hepatic encephalopathy: What is the evidence?
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Gluud LL, Dam G, Borre M, et al. Lactulose, rifaximin or branched chain amino acids for hepatic encephalopathy: what is the evidence? Metab Brain Dis 2013; 28:221-225; PubMed PMID: 23275147.
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Ferenci P. Hepatic Encephalopathy in Adults: Treatment. ©UptoDate. http:// www.uptodate.com/contents/hepatic-encephalopathy-in-adults-treatment. [Accessed on 21 August 2013]. This is a website describing up to date clinical studies of hyperammonia.
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Hepatic Encephalopathy in Adults: Treatment
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Ferenci, P.1
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PubMed PMID: 23653636. Pubmed Central PMCID: 3638683
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Wu D, Wu SM, Lu J, et al. Rifaximin versus nonabsorbable disaccharides for the treatment of hepatic encephalopathy: a meta-analysis. Gastroenterol Res Pract 2013; 2013:236963; PubMed PMID: 23653636. Pubmed Central PMCID: 3638683.
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Sharma BC, Sharma P, Lunia MK, et al. A randomized, double-blind, controlled trial comparing rifaximin plus lactulose with lactulose alone in treatment of overt hepatic encephalopathy. Am J Gastroenterol 2013; 108:1458-1463; PubMed PMID: 23877348.
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Rose CF. Ammonia-lowering strategies for the treatment of hepatic encephalopathy. Clin Pharmacol Therap 2012; 92:321-331; PubMed PMID: 22871998. Epub 2012/08/09. eng. An interesting review of molecular mechanisms that decrease amonia in hepatic encephalopathy in animal models and patients as of 2012.
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Clin Pharmacol Therap
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Rose, C.F.1
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PubMed PMID: 20335583. Epub 2010/03/26. eng
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Bass NM, Mullen KD, Sanyal A, et al. Rifaximin treatment in hepatic encephalopathy. N Engl J Med 2010; 362:1071-1081; PubMed PMID: 20335583. Epub 2010/03/26. eng.
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Bass, N.M.1
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Secondary prophylaxis of hepatic encephalopathy in cirrhosis: An open-label, randomized controlled trial of lactulose, probiotics, and no therapy
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PubMed PMID: 22710579
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Agrawal A, Sharma BC, Sharma P, Sarin SK. Secondary prophylaxis of hepatic encephalopathy in cirrhosis: an open-label, randomized controlled trial of lactulose, probiotics, and no therapy. Am J Gastroenterol 2012; 107:1043-1050; PubMed PMID: 22710579.
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Am J Gastroenterol
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Agrawal, A.1
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Muscle depletion increases the risk of overt and minimal hepatic encephalopathy: Results of a prospective study
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Merli M, Giusto M, Lucidi C, et al. Muscle depletion increases the risk of overt and minimal hepatic encephalopathy: results of a prospective study. Metab Brain Dis 2012; 28:281-284; PubMed PMID: 23224378. Epub 2012/12/12. Eng.
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Nutritional management contributes to improvement in minimal hepatic encephalopathy and quality of life in patients with liver cirrhosis: A preliminary, prospective, open-label study
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PubMed PMID: 22994429
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Kato A, Tanaka H, Kawaguchi T, et al. Nutritional management contributes to improvement in minimal hepatic encephalopathy and quality of life in patients with liver cirrhosis: a preliminary, prospective, open-label study. Hepatol Res 2013; 43:452-458; PubMed PMID: 22994429. This article demonstates the importance of the managing malnutrition common in patients with hepatic encephalopathy.
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Hepatol Res
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Kato, A.1
Tanaka, H.2
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Branched-chain amino acids increase arterial blood ammonia in spite of enhanced intrinsic muscle ammonia metabolism in patients with cirrhosis and healthy subjects
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PubMed PMID: 21636533
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Dam G, Keiding S, Munk OL, et al. Branched-chain amino acids increase arterial blood ammonia in spite of enhanced intrinsic muscle ammonia metabolism in patients with cirrhosis and healthy subjects. Am J Physiol Gastrointest Liver Physiol 2011; 301:G269-G277; PubMed PMID: 21636533.
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Bai M, Yang Z, Qi X, et al. l-ornithine-l-aspartate for hepatic encephalopathy in patients with cirrhosis: a meta-analysis of randomized controlled trials. J Gastroenterol Hepatol 2013; 28:783-792; PubMed PMID: 23425108.
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Acharya SK, Bhatia V, Sreenivas V, et al. Efficacy of L-ornithine L-aspartate in acute liver failure: a double-blind, randomized, placebo-controlled study. Gastroenterology 2009; 136:2159-2168; PubMed PMID: 19505424. Epub 2009/06/10. eng.
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Malaguarnera M, Bella R, Vacante M, et al. Acetyl-L-carnitine reduces depression and improves quality of life in patients with minimal hepatic encephalopathy. Scand J Gastroenterol 2011; 46:750-759; PubMed PMID: 21443422.
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PubMed PMID: 23751856
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Ventura-Cots M, Arranz JA, Simon-Talero M, et al. Safety of ornithine phenylacetate in cirrhotic decompensated patients: an open-label, doseescalating, single-cohort study. J Clin Gastroenterol 2013; 47:881-887; PubMed PMID: 23751856. The authors show the effective use of ornithinephenylacetate as a well tolerated and efficacious therapy for the first time in patients with cirrhosis and gastrointestinal bleeding.
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J Clin Gastroenterol
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Randomized, double-blind, controlled study of glycerol phenylbutyrate in hepatic encephalopathy
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PubMed PMID: 23847109
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Rockey DC, Vierling JM, Mantry P, et al. Randomized, double-blind, controlled study of glycerol phenylbutyrate in hepatic encephalopathy. Hepatology 2013; 56:248A; PubMed PMID: 23847109. This article describes the improvement in hepatic encephalopathy episodes in patients with a new drug (HPN-100) in the treatment of hepatic encephalopathy. The underlying mechanism has to be studied in more detail.
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Hepatology
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Rockey, D.C.1
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PubMed PMID: 23401201
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Laleman W, Simon-Talero M, Maleux G, et al. Embolization of large spontaneous portosystemic shunts for refractory hepatic encephalopathy: a multicenter survey on safety and efficacy. Hepatology 2013; 57:2448- 2457; PubMed PMID: 23401201. Embolization of these shunts has been shown to be effective immediately (within 100 days) in resolving hepatic encephalopathy. However, this treatment only works if there is residual liver function. It is less effective, and can be deleterious in patients with end-stage liver disease.
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Hepatology
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Simon-Talero M, Garcia-Martinez R, Torrens M, et al. Effects of intravenous albumin in patients with cirrhosis and episodic hepatic encephalopathy: a randomized double-blind study. J Hepatol 2013; 59: 1184-1192. The importance of this article is that albumin administration helps to prolong survival of patients with hepatic encephalopathy but did not prevent recurrence of hepatic encephalopathy.
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J Hepatol
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Simon-Talero, M.1
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