Article
Gastroenterology & Hepatology
Rajiv Jalan, Christopher F. Rose
Summary: The clinical progress in managing hepatic encephalopathy lags behind basic research, making current criteria for definition, classification, diagnosis, and grading difficult to apply reproducibly. Studies suggest that hepatic encephalopathy may be irreversible in many patients, requiring further research into neuronal injury and death mechanisms for future drug development. Lactulose, currently considered the standard of care, has poor clinical evidence for all severity levels of hepatic encephalopathy, and ethical consideration should be given to placebo-controlled trials.
JOURNAL OF HEPATOLOGY
(2022)
Review
Gastroenterology & Hepatology
Leen Z. Hasan, George Y. Wu
Summary: Hepatic encephalopathy is a devastating complication of chronic liver disease with high mortality rates, and current treatment modalities, while promising, are limited by study design and lack of safety data.Various treatment options targeting gut microbiota, oxidative stress, and neurotransmitter modulation have shown promise but more research is needed to address their limitations.
JOURNAL OF CLINICAL AND TRANSLATIONAL HEPATOLOGY
(2021)
Review
Gastroenterology & Hepatology
Dominique Thabut, Charlotte Bouzbib, Lucy Meunier, Manon Haas, Nicolas Weiss, Alexandre Louvet, Francois Imbert-Bismut, Fanny Mochel, Yann Nadjar, Antoine Santiago, Thierry Thevenot, Veronique Duhalde, Frederic Oberti, Claire Francoz, Audrey Coilly, Marie-Noelle Hilleret, Pascal Lebray, Amelie Liou-Schischmanoff, Louise Barbier, Christophe Duvoux, Georges-Philippe Pageaux, Michael Bismuth, Damien Galanaud, Thomas De Broucker, Jean-Francois Cadranel, Vincent Leroy, Vincent Di Martino, Dominique Larrey, Christophe Camus, Olivier Scatton, Victor De Ledinghen, Ariane Mallat, Marika Rudler, Christophe Bureau
Summary: Hepatic encephalopathy (HE) is a frequent and severe complication of liver disease that often goes undiagnosed due to a lack of understanding and consensus on diagnosis. Non-specific symptoms and comorbidities in cirrhotic patients make differential diagnosis challenging. Guidelines are provided to assist clinicians in diagnosing and treating HE. Liver transplantation may be indicated for HE, but its reversibility post-transplantation and the consequences in patients with other neurological disorders remain controversial.
LIVER INTERNATIONAL
(2023)
Review
Medicine, General & Internal
Daniele Bellafante, Stefania Gioia, Jessica Faccioli, Oliviero Riggio, Lorenzo Ridola, Silvia Nardelli
Summary: Hepatic encephalopathy (HE) is a common complication in advanced liver disease, characterized by neurological and psychiatric symptoms. Malnutrition and portosystemic shunts have recently been identified as new precipitating factors for HE, in addition to known factors such as infections and gastrointestinal bleeding. It is crucial to identify, manage, and correct these factors for effective treatment of HE, along with pharmacological therapy.
JOURNAL OF CLINICAL MEDICINE
(2023)
Article
Biochemical Research Methods
Katerina Kroupina, Chantal Bemeur, Christopher F. Rose
Summary: Hepatic encephalopathy is a decline in brain function caused by liver insufficiency. The liver's reduced ability to clear ammonia plays a crucial role in the development of hepatic encephalopathy. Cirrhotic patients require high protein intake, but this can increase the accumulation of ammonia, worsening hepatic encephalopathy. Finding a nutritional solution that provides sufficient protein doses without increasing the risk of hepatic encephalopathy is necessary.
ANALYTICAL BIOCHEMISTRY
(2022)
Article
Gastroenterology & Hepatology
Stefania Gioia, Lorenzo Ridola, Ludovica Cristofaro, Manuela Merli, Jessica Faccioli, Oliviero Riggio, Silvia Nardelli
Summary: This study found that after TIPS procedure, not only muscle mass but also adipose tissue underwent changes. Improvement in subcutaneous adipose tissue, sarcopenia, and myosteatosis were associated with cognitive impairment improvement, independently of liver function. The correlation between adipose tissue and ammonia modification suggests a potential role of adipose tissue in ammonia trafficking between organs.
LIVER INTERNATIONAL
(2021)
Article
Endocrinology & Metabolism
Anne Catrine Daugaard Mikkelsen, Karen Louise Thomsen, Hendrik Vilstrup, Niels Kristian Aagaard
Summary: Patients with cirrhosis are prone to electrolyte disorders, including hypokalaemia, which can lead to an increased risk of hepatic encephalopathy. Hypokalaemia stimulates renal ammonia production and reduces hepatic ammonia elimination, resulting in hyperammonaemia. Furthermore, hypokalaemia facilitates the entrance of ammonia into the central nervous system and increases the amount of gaseous ammonia passing the blood brain barrier. Correcting low potassium levels is crucial in the management of cirrhosis patients to prevent hepatic encephalopathy.
METABOLIC BRAIN DISEASE
(2023)
Article
Pharmacology & Pharmacy
Ziyou Bao, Xiaotong Chen, Yan Li, Wenshan Jiang, Di Pan, Lushun Ma, Yunxiao Wu, Yunling Chen, Chaojia Chen, Liyuan Wang, Songbo Zhao, Tixiao Wang, Wei-Yang Lu, Chunhong Ma, Shuanglian Wang
Summary: Macrophages in the liver can change their function in response to hepatitis B virus (HBV) infection. This study shows that GABA signaling in macrophages can promote a specific type of macrophage polarization (M2-like), which leads to increased replication of HBV in mice. The activation of GABA receptors enhances HBV replication by suppressing the immune response of liver macrophages.
ANTIVIRAL RESEARCH
(2023)
Review
Gastroenterology & Hepatology
Silvia Nardelli, Stefania Gioia, Jessica Faccioli, Oliviero Riggio, Lorenzo Ridola
Summary: Hepatic encephalopathy is a brain dysfunction seen in liver cirrhosis, characterized by neurological and psychiatric symptoms. Treatment usually involves the use of non-absorbable antibiotics and disaccharides. The efficacy of other medications remains under debate and requires further research.
EXPERT REVIEW OF GASTROENTEROLOGY & HEPATOLOGY
(2023)
Review
Immunology
Zefeng Chen, Jingsheng Ruan, Dinghua Li, Min Wang, Zhiwei Han, Wenxia Qiu, Guobin Wu
Summary: Hepatic encephalopathy is a neurological disorder that occurs in patients with liver insufficiency, and its pathogenesis has not been fully elucidated. Pharmacotherapy is the main therapeutic option for HE, which targets the pathogenesis of HE by reducing ammonia levels, improving neurotransmitter signal transduction, and modulating intestinal microbiota. The intestinal microbiota is closely associated with multiple links in the pathogenesis of HE, and restoring the homeostasis of intestinal bacteria or providing specific probiotics has significant effects on neurological disorders in HE.
FRONTIERS IN CELLULAR AND INFECTION MICROBIOLOGY
(2021)
Review
Medicine, General & Internal
Kapil Sharma, Shivani Akre, Swarupa Chakole, Mayur B. Wanjari
Summary: Hepatic encephalopathy is a condition commonly seen in individuals with liver cirrhosis, resulting in personality changes, intellectual impairment, and decreased level of consciousness. While many symptoms can be treated early, the exact pathophysiology of HE is still debated, with theories focusing on neurotoxins, altered neurotransmission, systemic inflammation, and metabolic irregularities in liver failure.
CUREUS JOURNAL OF MEDICAL SCIENCE
(2022)
Article
Biochemistry & Molecular Biology
Rafael Ochoa-Sanchez, Farzaneh Tamnanloo, Christopher F. Rose
Summary: Hepatic encephalopathy (HE) is a neuropsychiatric syndrome associated with liver disease, reversible in theory but leading to persistent neurological complications in some patients post-liver transplantation. These enduring complications impact quality of life and healthcare costs, highlighting the need for further understanding of the underlying mechanisms.
NEUROCHEMICAL RESEARCH
(2021)
Article
Public, Environmental & Occupational Health
Lina Zhao, Shaowei Hou, Risu Na, Bin Liu, Zhiwei Wang, Yun Li, Keliang Xie
Summary: This retrospective cohort study aimed to explore the relationship between serum ammonia levels and prognosis of sepsis-associated encephalopathy (SAE) patients. The findings show that serum ammonia level is not significantly associated with hospital mortality in SAE patients, but is correlated with higher SOFA scores and lactate levels. SAPS II and Charlson scores were identified as independent risk factors for death in SAE patients.
FRONTIERS IN PUBLIC HEALTH
(2023)
Article
Biochemistry & Molecular Biology
Laurent Galineau, Nicolas Arlicot, Anne-Claire Dupont, Frederic Briend, Emmanuelle Houy-Durand, Clovis Tauber, Marie Gomot, Valerie Gissot, Laurent Barantin, Antoine Lefevre, Johnny Vercouillie, Catherine Roussel, Sylvie Roux, Lydie Nadal, Sylvie Mavel, Frederic Laumonnier, Catherine Belzung, Sylvie Chalon, Patrick Emond, Maria-Joao Santiago-Ribeiro, Frederique Bonnet-Brilhault
Summary: This study aimed to investigate glutamate dysfunctions in adult subjects with autism spectrum disorder (ASD). The results showed no significant modifications in glutamate levels, but an overall increased density in mGluR5. This suggests that clinical changes in mGluR5 density may reflect the adaptation of earlier glutamate dysfunctions.
MOLECULAR PSYCHIATRY
(2023)
Article
Biochemical Research Methods
Maxime Mallet, Victor Desplats, Charlotte Bouzbib, Philippe Sultanik, Imen Alioua, Marika Rudler, Nicolas Weiss, Dominique Thabut
Summary: Ammonemia plays a significant role in the development of hepatic encephalopathy in patients with chronic liver diseases. It can not only be used for differential diagnosis but also serve as a prognostic marker, indicating a potential toxic effect of ammonia even in patients without neurological symptoms.
ANALYTICAL BIOCHEMISTRY
(2022)
Article
Gastroenterology & Hepatology
Zhou Yuming, Tang Ruqi, Merrill Eric Gershwin, Ma Xiong
CLINICS IN LIVER DISEASE
(2024)
Article
Gastroenterology & Hepatology
Inbal Houri, Gideon M. Hirschfield
CLINICS IN LIVER DISEASE
(2024)
Article
Gastroenterology & Hepatology
Yasameen Muzahim, Ali Wakil, Mehak Bassi, Nikolaos Pyrsopoulos
CLINICS IN LIVER DISEASE
(2024)
Article
Gastroenterology & Hepatology
Brian H. Horwich, Douglas T. Dieterich
CLINICS IN LIVER DISEASE
(2024)
Article
Gastroenterology & Hepatology
Aparna Goel, Paul Kwo
Summary: The goal of autoimmune hepatitis treatment is achieving clinical and biochemical remission. Standard care involves induction treatment with corticosteroids and gradual tapering of steroids. Alternatives to standard therapy can be considered for patients with intolerance or inadequate response. Treatment withdrawal is achievable in less than 20% of patients after 2 years of sustained remission, and liver transplantation should be considered for patients with progressive disease or complications.
CLINICS IN LIVER DISEASE
(2024)
Article
Gastroenterology & Hepatology
Mariana Zapata, Hendrick Pagan-Torres, Marlyn J. Mayo
CLINICS IN LIVER DISEASE
(2024)
Article
Gastroenterology & Hepatology
Aalam Sohal, Sanya Kayani, Kris Kowdley
Summary: Primary sclerosing cholangitis (PSC) is an immune-mediated liver disease characterized by inflammation and fibrosis of bile ducts. It is commonly associated with inflammatory bowel disease, especially ulcerative colitis. The natural history of the disease varies among patients, but most will develop cirrhosis.
CLINICS IN LIVER DISEASE
(2024)
