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Hepatic Encephalopathy

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A syndrome characterized by central nervous system dysfunction in association with LIVER FAILURE, including portal-systemic shunts. Clinical features include lethargy and CONFUSION (frequently progressing to COMA); ASTERIXIS; NYSTAGMUS, PATHOLOGIC; brisk oculovestibular reflexes; decorticate and decerebrate posturing; MUSCLE SPASTICITY; and bilateral extensor plantar reflexes (see REFLEX, BABINSKI). ELECTROENCEPHALOGRAPHY may demonstrate triphasic waves. (From Adams et al., Principles of Neurology, 6th ed, pp1117-20; Plum & Posner, Diagnosis of Stupor and Coma, 3rd ed, p222-5)

Also Known As:

Encephalopathy, Hepatocerebral; Encephalopathy, Portal-Systemic; Encephalopathy, Portosystemic; Fulminant Hepatic Failure with Cerebral Edema; Hepatic Coma; Hepatic Stupor; Hepatocerebral Encephalopathy; Portal-Systemic Encephalopathy; Coma, Hepatic; Comas, Hepatic; Encephalopathies, Hepatic; Encephalopathies, Hepatocerebral; Encephalopathies, Portal-Systemic; Encephalopathies, Portosystemic; Encephalopathy, Portal Systemic; Hepatic Comas; Hepatic Encephalopathies; Hepatic Stupors; Hepatocerebral Encephalopathies; Portal Systemic Encephalopathy; Portal-Systemic Encephalopathies; Portosystemic Encephalopathies; Stupor, Hepatic; Stupors, Hepatic; Encephalopathy, Hepatic; Portosystemic Encephalopathy

Networked: 3480 relevant articles (224 outcomes, 392 trials/studies)

Relationship Network

Disease Context: Research Results

Related Diseases

1.	Fibrosis (Cirrhosis)
2.	Liver Cirrhosis (Hepatic Cirrhosis)
3.	Hyperammonemia
4.	Acute Liver Failure (Fulminant Hepatic Failure)
5.	Ascites

Experts

1.	Felipo, Vicente: 37 articles (09/2015 - 12/2005)
2.	Butterworth, Roger F: 25 articles (09/2015 - 05/2002)
3.	Häussinger, Dieter: 22 articles (02/2015 - 05/2002)
4.	Vilstrup, Hendrik: 22 articles (01/2015 - 01/2006)
5.	Albrecht, Jan: 21 articles (09/2015 - 02/2004)
6.	Jalan, Rajiv: 19 articles (01/2015 - 11/2002)
7.	Sharma, Praveen: 19 articles (06/2014 - 06/2008)
8.	Sharma, Barjesh Chander: 18 articles (09/2015 - 09/2009)
9.	Görg, Boris: 18 articles (02/2015 - 05/2002)
10.	Córdoba, Juan: 18 articles (01/2015 - 12/2002)

Drugs and Biologics

Drugs and Important Biological Agents (IBA) related to Hepatic Encephalopathy:

1.	Lactulose (Duphalac)FDA LinkGeneric 10/01/2012 - "Compared to placebo or lactulose, treatment with probiotics or synbiotics significantly improved hepatic encephalopathy (RR = 1.40, 95% CI = 1.05-1.86, I(2) = 5%). " 01/01/2011 - "A possible case of minimal hepatic encephalopathy treated successfully with lactulose." 01/01/1994 - "In contrast, the time required for a lactulose load to reach the cecum was significantly greater in the patients with hepatic encephalopathy (p < 0.01) and increased as a function of the hepatic encephalopathy grade.(ABSTRACT TRUNCATED AT 250 WORDS)" 05/01/2014 - "Lactulose therapy was effective for cirrhotic patients as primary prophylaxis to prevent overt hepatic encephalopathy (OHE) episodes. " 07/01/2012 - "Lactulose is effective in secondary prophylaxis of hepatic encephalopathy (HE). "
2.	rifaximin (L 105)FDA Link 04/01/2014 - "Over a 6-month period, treatment with Rifaximin failed to maintain remission from hepatic encephalopathy more effectively than placebo in the studied group." 03/25/2010 - "Over a 6-month period, treatment with rifaximin maintained remission from hepatic encephalopathy more effectively than did placebo. " 10/15/2007 - "In contrast, rifaximin is safe and effective in hepatic encephalopathy, but is more expensive. " 01/01/2013 - "Many studies have found that the antibiotic rifaximin is effective for the treatment of hepatic encephalopathy. " 05/01/2014 - "Rifaximin is widely used for the treatment of hepatic encephalopathy. "
3.	AmmoniaIBA 09/01/2003 - "Serum biochemical parameters and blood ammonia levels, liver histology, stage of hepatic encephalopathy, and survival were statistically significantly improved in TAA-intoxicated and rG-CSF-treated rats compared to TAA-intoxicated and saline-treated ones. " 07/01/2014 - "Ammonia levels were slightly increased without exacerbating hepatic encephalopathy, and the protein nutrition state consequently improved. " 12/01/2003 - "pylori has been shown to improve the blood ammonia levels and hepatic encephalopathy." 06/01/2013 - "Data from both animal and human studies sustain that there is a synergistic effect between systemic oxidative stress, and ammonia that is implicated in the pathogenesis of hepatic encephalopathy." 06/01/2011 - "However, previous studies on the relationship between ammonia and the severity of hepatic encephalopathy have yielded variable results. "
4.	Flumazenil (Romazicon)FDA LinkGeneric 08/01/1997 - "In a placebo-controlled study involving patients with mild hepatic encephalopathy, a low dose of flumazenil (0.2 mg/kg) resulted in a significant improvement in reaction time.Research" 04/01/1995 - "The infusion of 0.4-1 mg flumazenil results in a modest but rapid improvement in the EEG grading of hepatic encephalopathy and to a moderate but delayed improvement in the clinical grade of hepatic encephalopathy." 03/01/2006 - "Is flumazenil an effective treatment for hepatic encephalopathy?" 01/01/1994 - "To test this possibility, we conducted a double-blind, placebo-controlled crossover trial of the efficacy of flumazenil in cirrhotic patients in hepatic coma. " 04/01/1995 - "During 12 episodes of hepatic encephalopathy, flumazenil was administered and the EEG recording improved within 7 min (range 4-47 min; 12 out of 18 cases; 66 versus 0% for flumazenil versus placebo, respectively; P < 0.01); a modest clinical improvement in hepatic encephalopathy was observed within 83 min (range 30-340 min). "
5.	BilirubinIBA 01/01/2012 - "The Molecular Adsorbent Recirculating System is associated with a significant improvement in total bilirubin levels and hepatic encephalopathy but has no impact on survival. " 01/01/2012 - "By meta-analysis, MARS resulted in a significant decrease in total bilirubin levels (net change -7.0 mg/dl; 95% CI -10.4, -3.7; p < 0.001) and in an improvement in the West-Haven grade of hepatic encephalopathy (odds ratio [OR] 3.0; 95% CI 1.9, 5.0; p < 0.001). " 01/01/2012 - "We evaluated net change in total bilirubin levels, improvement in hepatic encephalopathy and mortality. " 11/01/2005 - "hepatic encephalopathy) and the laboratory indices (serum total bilirubin and prothrombin time) of the treatment group patients were obviously improved compared with those of the control group patients (P < 0.05). " 01/01/2003 - "Bilirubin levels and hepatic encephalopathy improved under MARS therapy. "
6.	ornithylaspartateIBA 11/01/2008 - "L-ornithine-L-aspartate infusions were found to be effective in cirrhotic patients with hepatic encephalopathy." 06/01/2005 - "L-ornithine-L-aspartate is effective for hepatic encephalopathy and has not obvious side effect." 06/01/1998 - "L-ornithine-L-aspartate in experimental portal-systemic encephalopathy: therapeutic efficacy and mechanism of action." 05/01/1998 - "Also, the mental state grade (p<0.05) and the Portosystemic Encephalopathy Index (p<0.01), improved to a much greater degree in the L-ornithine-L-aspartate group than in the placebo group. " 11/01/2011 - "To evaluate the efficacy of L-ornithine-L-aspartate (LOLA) as an adjuvant therapy in cirrhotic patients with hepatic encephalopathy (HE). "
7.	lactitolIBA 02/01/1995 - "[Lactitol suppresses the disturbance of consciousness caused by experimentally induced hepatic encephalopathy in rats: an EEG study]." 11/01/1994 - "A perinatal and postnatal study of lactitol, a hepatic encephalopathy drug was conducted in Sprague-Dawley rats. " 11/01/1994 - "A teratogenicity study of lactitol, a hepatic encephalopathy drug, was conducted in Sprague-Dawley rats. " 11/01/1994 - "13-week repeated dose toxicity studies were conducted on lactitol, a hepatic encephalopathy drug. " 11/01/1994 - "The single dose toxicity studies of lactitol, a hepatic encephalopathy drug, were performed in ddY mice and SD rats of both sexes by administering the drug orally, intravenously or subcutaneously. "
8.	ZincIBA 11/01/2010 - "Zinc supplementation is effective in hepatic encephalopathy and consequently improves patients HRQOL." 04/01/1991 - "Long-term zinc supplementation improved severe recurrent hepatic encephalopathy and therefore the quality of life." 01/01/2013 - "The aim of this study was to assess the effects of oral zinc supplementation in the treatment of hepatic encephalopathy. " 01/01/1994 - "Although some reports indicate beneficial effects of oral zinc supplementation in cirrhotic patients with hepatic encephalopathy, not all studies have been positive. " 08/01/1993 - "The patients who never showed clinical signs of hepatic encephalopathy during the trial were 88.6% in zinc-group and 86% in only standard therapy group. "
9.	Sorbitol (Yal)FDA Link 08/01/2002 - "Hepatic plasma flow was estimated in patients with acute liver failure after development of hepatic encephalopathy grade III, by the use of liver vein catheterization and continuous infusion of sorbitol. " 06/01/1981 - "Sorbitol solution has been used to a control substance of evaluating the efficacy of lactulose therapy for hepatic encephalopathy (HE). " 03/01/1998 - "Hepatic plasma flow estimated according to Fick's principle in patients with hepatic encephalopathy: evaluation of indocyanine green and D-sorbitol as test substances." 09/01/1984 - "Portal systemic encephalopathy-sorbitol--a potential replacement for lactulose." 05/01/1983 - "These findings indicate that both sorbitol and lactulose are extensively fermented by the colonic flora and that the possibility of replacing lactulose with the much cheaper sorbitol in the treatment of portal-systemic encephalopathy ought to be investigated. "
10.	Branched-Chain Amino AcidsIBA 07/01/1983 - "Is intravenous administration of branched chain amino acids effective in the treatment of hepatic encephalopathy? " 11/01/1986 - "The efficacy of branched chain amino acids in two consecutive clinical studies in patients with severe hepatic encephalopathy was tested. " 09/01/2011 - "Losses to follow-up limit conclusions regarding the efficacy of branched-chain amino acids in patients with hepatic encephalopathy." 01/01/2015 - "A Cochrane systematic review including 11 randomised clinical trials on branched-chain amino acids (BCAA) versus control interventions has evaluated if BCAA may benefit people with hepatic encephalopathy. " 01/01/2015 - "A Cochrane systematic review including 11 randomised clinical trials on branched-chain amino acids (BCAA) versus control interventions has evaluated if BCAA may benefit people with hepatic encephalopathy. "

Therapies and Procedures

1.	Surgical Portasystemic Shunt (Portosystemic Shunt) 06/01/2014 - "Embolisation of a large spontaneous portosystemic shunt may be associated with improved survival and liver function, as well as prevention of hepatic encephalopathy in cirrhotic patients with recurrent hepatic encephalopathy and modestly preserved liver function." 06/01/2014 - "Improvement in survival associated with embolisation of spontaneous portosystemic shunt in patients with recurrent hepatic encephalopathy." 10/01/2015 - "Our study further demonstrates the value of the canine congenital portosystemic shunt as a naturally occurring spontaneous model of human hepatic encephalopathy. " 09/01/2015 - "The aim of this study was to analyze brain reserve in abstinent alcoholic cirrhotic (Alc) patients compared to nonalcoholic cirrhotic (Nalc) patients in the context of hepatic encephalopathy (HE) and to evaluate relative change in brain reserve between groups over time and before and after elective transjugular intrahepatic portosystemic shunt (TIPS) placement. " 01/01/2015 - "Our recent studies have demonstrated that the pathophysiology of canine hepatic encephalopathy is very similar to human hepatic encephalopathy, which provides strong support for the use of dogs with a congenital portosystemic shunt as a naturally occurring model of human hepatic encephalopathy. "
2.	Liver Transplantation 08/01/2003 - "These were associated with a improvement of the patients' clinical conditions including hepatic encephalopathy, deranged hemodynamic situation, as well as renal and respiratory function, thus resulted into marked decrease of sequential organ failure assessment (SOFA) score (from 9.72+-1.89 to 6.98+-2.34), and improving outcome: 9 patients were able to be discharged from the hospital or bridged to successful liver transplantation. " 06/01/2007 - "P300 cognitive evoked potentials have been shown to be effective for the assessment of mild hepatic encephalopathy but no investigations of their use with liver transplantation has been conducted. " 04/01/1992 - "Surgical haemostatis with partial or total resection of the colonoplasty was only temporarily effective in our patient, who subsequently underwent liver transplantation due to repeated episodes of hepatic encephalopathy. " 09/07/2010 - "Patients were followed every 3 or 6 months until the development of hepatic encephalopathy or liver transplantation, death, or the end of the study. " 07/01/2002 - "The aim of this study is to evaluate the role of spectral electroencephalogram (EEG) analysis ((S)EEG) in quantitating brain dysfunction in cirrhotic patients, showing conditions of minimal hepatic encephalopathy (HE), and determining the impact of orthotopic liver transplantation (OLT) on its correction. "
3.	Transplantation (Transplant Recipients) 01/01/2012 - "CCl(4)-induced hepatic encephalopathy was also improved by 3-genes iPSC transplantation. " 01/01/2016 - "Fecal microbiota transplantation in the management of hepatic encephalopathy." 07/01/2015 - "TIPS placement may be useful as a bridging tool to transplantation unless hepatic encephalopathy is present. " 04/01/2013 - "Hepatic encephalopathy in a liver transplant recipient with stable liver function." 03/01/2012 - "Early transplantation increases survival of patients with acute hepatic encephalopathy. "
4.	Aftercare (After-Treatment) 07/01/2003 - "In all patients, complete obliteration or nearly complete obliteration was confirmed angiographically, and symptoms related to portal-systemic encephalopathy improved after treatment. " 10/01/2005 - "After treatment with SAD, the clinical symptoms and signs were improved and the hemodynamics were stabilized, complications were ameliorated partially, in particular hepatic encephalopathy was improved, with low incidence of adverse reaction, and the effective rate and survival rate were high. " 09/01/2015 - "Changes in bispectral index after treatment corresponded to cut-off scores for grades of overt and minimal hepatic encephalopathy. " 07/01/2013 - "Serum endotoxin, inflammatory mediators, and magnetic resonance spectroscopy before and after treatment in patients with minimal hepatic encephalopathy." 02/22/2003 - "Before and after treatment, portosystemic encephalopathy (PSE) stage and number connection test (NCT) scores were checked every half hour for 5 hours. "
5.	Surgical Portacaval Shunt (Portacaval Anastomosis) 11/01/1988 - "The objective of this study was to assess the prognostic value of spontaneous portosystemic shunting and liver function for survival and spontaneous hepatic encephalopathy after end-to-side portacaval shunt in cirrhotic patients. " 06/01/1977 - "A sequential light and electron microscopic study of cerebral cortex was performed in a rat model of portal-systemic encephalopathy produced by creating a portacaval shunt and followed by ammoniate resin feedings. " 12/01/2014 - "Neuroinflammation plays a main role in neurological deficits in rats with minimal hepatic encephalopathy (MHE) due to portacaval shunt (PCS). " 11/01/2013 - "Futhermore the portacaval shunt will not be expanded, therefore it can significantly reduce the incidence of hepatic encephalopathy." 01/10/2012 - "Progressive reduction of sleep time and quality in rats with hepatic encephalopathy caused by portacaval shunts."