Current recommendations for the treatment of hepatic encephalopathy are based, to a large extent, on open or uncontrolled trials, undertaken in very small numbers of patients. In consequence, there is ongoing discussion as to whether the classical approach to the treatment of this condition, which aims at reducing ammonia production and absorption using either non-absorbable disaccharides and/or antibiotics, should be revisited, modified or even abandoned. Pros and cons of present therapeutic strategies and possible future developments were discussed at the fourth International Hannover Conference on Hepatic Encephalopathy held in Dresden in June 2006. The content of this discussion is summarized.
"The use of a placebo in severe cases of HE is unjustified, and in HE treatment trials comparisons with disaccharides as controls are not adequate [7,21]. Thus, the comparison with another antibiotic enabled the correlation of our results with many other studies. "
[Show abstract][Hide abstract] ABSTRACT: Background
Hepatic encephalopathy (HE) is a severe complication in patients with hepatic cirrhosis, which causes numerous hospital admissions and deaths. Antibiotics are the best options in HE treatment, but head-to-head comparisons between these drugs are scarce. Erythromycin combines the antimicrobial effect and prokinetic properties in the same drug, but it has never been used in HE treatment. Our aim was to evaluate the efficacy of erythromycin as an HE treatment.
We achieved a randomized controlled trial of adult patients with HE and hepatic cirrhosis admitted in our hospital. After randomization, the subjects received either erythromycin 250 mg or neomycin 1 g orally QID until hospital discharge or prescription of another antibiotic. All subjects were blindly evaluated every day towards quantifying clinical, neuropsychometric, hepatic and renal exams. Statistical analysis was employed to compare the groups and correlate the variables with hospitalization duration.
30 patients were evaluated (15 treated with each drug). At hospital admission, the groups were homogeneous, but the erythromycin group subjects achieved a shorter hospitalization stay (p = 0.032) and a more expressive reduction in alanine aminotranspherase levels (p = 0.026). Hospitalization duration was positively correlated with C reactive protein levels measured previous to (p = 0.015) and after treatment (p = 0.01).
In the sample evaluated erythromycin was associated with significant reductions in hospital stay and in alanine aminotranspherase values. Hospitalization time was positive correlated with C reactive protein levels measured before and after the treatments.
"Such interrelationships might provide a scientific basis for any 'gut feeling' or the above-mentioned Asian understanding of the gut being the centre of spiritual and physical strength. The first hints that CNS diseases such as hepatic encephalopathy, depression and autism spectrum disorder might be treated by modulating the GI microbiome (for example, with the prebiotic and laxative lactulose, sugar-reduced diets or antibiotics) is a further argument for the relevance of the GBA [58-60]. Moreover, experimental data have shown that probiotics, by modifying the GI microbiome, can affect both the ENS  and the CNS , which highlights the relevance of the CNS for gut health. "
[Show abstract][Hide abstract] ABSTRACT: 'Gut health' is a term increasingly used in the medical literature and by the food industry. It covers multiple positive aspects of the gastrointestinal (GI) tract, such as the effective digestion and absorption of food, the absence of GI illness, normal and stable intestinal microbiota, effective immune status and a state of well-being. From a scientific point of view, however, it is still extremely unclear exactly what gut health is, how it can be defined and how it can be measured. The GI barrier adjacent to the GI microbiota appears to be the key to understanding the complex mechanisms that maintain gut health. Any impairment of the GI barrier can increase the risk of developing infectious, inflammatory and functional GI diseases, as well as extraintestinal diseases such as immune-mediated and metabolic disorders. Less clear, however, is whether GI discomfort in general can also be related to GI barrier functions. In any case, methods of assessing, improving and maintaining gut health-related GI functions are of major interest in preventive medicine.
BMC Medicine 03/2011; 9(1):24. DOI:10.1186/1741-7015-9-24 · 7.25 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Hepatic encephalopathy (HE) is a syndrome of neuropsychiatric dysfunction caused by portosystemic venous shunting, with or without intrinsic liver disease. Patients with hepatic encephalopathy often present with the onset of mental status changes ranging from subtle psychologic abnormalities to profound coma. Several hypotheses have been proposed to explain the mental impairment associated with portosystemic shunting and liver disease. Clinicians diagnosing HE frequently have the opportunity to intervene and reverse severe HE, even hepatic coma. The recent advances in understanding and management of HE are the subject of this article.
Medical Clinics of North America 08/2008; 92(4):795-812, viii. DOI:10.1016/j.mcna.2008.03.009 · 2.61 Impact Factor
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