1,721,052 research outputs found
Emerging drugs for hepatic encephalopathy
No full textBackground: Hepatic encephalopathy (HE) is a severe complication of cirrhosis, seriously affecting the patients' quality of life. The classical approach aimed at reducing the production of gut-derived toxins, such as ammonia, is under debate as, at the moment, the information obtained from the clinical trials does not support any specific treatment for HE. Objectives: i) To discuss present therapeutic strategies and possible future developments; ii) to identify areas of medical needs and iii) to suggest the ideal design and methodology for randomized controlled trials (RCTs) in HE. Methods: Current approaches were obtained from already available RCTs or from experimental animal studies. Those approaches developed from studies on HE pathophysiology were considered as working hypotheses for future therapies. Results/conclusion: Our competence in testing old and new treatment modalities by RCTs with appropriate clinically relevant end points should urgently be improved. The patients at risk of HE are identifiable, and studies specifically aimed at establishing whether HE may be prevented or not are needed. As far as new treatment modalities are concerned, RCTs on the modulators of the intestinal bacterial flora and on the molecular adsorbent recirculating system are already available, but further studies are needed to confirm these promising approaches
Hepatic encephalopathy therapy: An overview.
No full textType-C hepatic encephalopathy (HE) is a severe complication of cirrhosis, which seriously affects quality of life and is strongly related to patient survival. Treatment based on a classical pharmacological approach that is aimed at reducing the production of gut-derived toxins, such as ammonia, is still under debate. Currently, results obtained from clinical trials do not support any specific treatment for HE and our competence in testing old and new treatment modalities by randomized controlled trials with appropriate clinically relevant end-points urgently needs to be improved. On the other hand, patients who are at risk for HE are now identifiable, based on studies on the natural history of the disease. Today, very few studies that are specifically aimed at establishing whether HE may be prevented are available or in progress. Recent studies have looked at non absorbable disaccharides or antibiotics and other treatment modalities, such as the modulation of intestinal flora. In the treatment of severe stage HE, artificial liver supports have been tested with initial positive results but more studies are needed
Hepatic encephalopathy after transjugular intrahepatic portosystemic shunt: still a major problem.
No full textComment on
Two hypotheses for decreasing hepatic encephalopathy risk after transjugular intrahepatic portosystemic shunt. [Hepatology. 2010
Hepatic encephalopathy in the 21st century. Still an emerging topic
Full text linkWhy write about hepatic encephalopathy (HE) in the twenty-first century [...]
Non-invasive tests for fibrosis detection: still in search for the best way
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Albumin for cognitive impairment after TIPS: a road to be explored
No full textTransjugular intrahepatic portosystemicshunt (TIPS) iswidelyusedtotreatsomecomplicationsof portal hypertension, suchas recurrent variceal bleedingor refractoryascites,byshuntingbloodflowbypassingthe liverandconsequently reducingportal pressure,with theaimof reducingmortality andbridgingpatients to liver transplant.TIPSoftenrepresentsalife-savingprocedure,butis characterized, due to the blood diversion directly into the systemiccirculation,bythedevelopmentofHE,particularlyin theperiodimmediatelyaftertheprocedure.2Todate,theroleof drugtherapyforHEprophylaxisafterTIPSisnotyetsupported by strong scientific evidence.3 Given this premise, TIPS recipientscouldalsobeconsideredat high riskofH
Hepatic encephalopathy – recent advances in treatment and diagnosis
No full textIntroduction Hepatic encephalopathy (HE) is a peculiar kind of brain dysfunction typical of liver cirrhosis characterized by nonspecific neurological and psychiatric manifestations. HE ranges from minimal hepatic encephalopathy (MHE) to the most severe form characterized by alteration of consciousness or coma (overt HE, OHE). Once the diagnosis of OHE is made, every effort to identify and correct the precipitating cause is essential for the resolution of symptoms. Clinical studies that assessed the prevalence and incidence of any type of HE (MHE and OHE) in patients affected by cirrhosis were included in this review. No language, publication date, or publication status restrictions were imposed. The studies were identified by searching electronic databases (PubMed and SCOPUS).Areas covered The most widely empirical pharmacological approach consists of non-absorbable antibiotics (rifaximin) and non-absorbable disaccharides (lactulose, lactitol per os and per enemas). Other agents (including branched-chain amino acids, probiotics, other antibiotics, or intravenous L-ornithine L-aspartate) are available, but the evidence supporting their efficacy remains under debate.Expert opinion Gray areas and future needs remain the therapeutic approach to MHE and issues in the design of therapeutic studies for HE which have been extensively discussed in this review
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