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
Fin S. Larsen, Faouzi Saliba
Summary: Acute liver failure (ALF) leads to numerous complications, resulting in multi-organ failure. This review focuses on the pathophysiological processes and management strategies using artificial liver support and liver transplantation (LT). The deterioration in ALF is caused by hyperammonemia and release of DAMPs, leading to hepatic encephalopathy, cerebral edema, and inflammatory activation. Continuous renal replacement therapy (CRRT) and plasma exchange are effective in removing ammonia and DAMPs. LT criteria for non-paracetamol cases are robust, but criteria for paracetamol-intoxicated patients are more unreliable. Post-LT survival rates have significantly improved, reaching 90% for patients needing LT for survival.
LIVER INTERNATIONAL
(2023)
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)
Article
Gastroenterology & Hepatology
Priti Vijay, Bikrant Bihari Lal, Vikrant Sood, Rajeev Khanna, Yashwant Patidar, Seema Alam
Summary: The study found that optic nerve sheath diameter (ONSD) is an effective indicator for detecting raised intracranial pressure in pediatric acute liver failure patients. An ONSD greater than 4.55 mm indicates elevated ICP. Timely reduction in ONSD can predict patient outcomes.
HEPATOLOGY INTERNATIONAL
(2021)
Article
Gastroenterology & Hepatology
Viniyendra Pamecha, Nilesh Sadashiv Patil, Sanyam Falari, Nihar Mohapatra, Anubhav Harshit Kumar, Gaurav Sindwani, Neha Garg, Seema Alam, Rajeev Khanna, Vikrant Sood, Bikrant Bihari Lal
Summary: This study aimed to investigate the challenges and outcomes of live-donor liver transplantation (LDLT) for pediatric acute liver failure (PALF). A total of 315 patients with PALF were treated over 11 years, and 42 underwent liver transplantation. The outcomes of LDLT for PALF were analyzed.
HEPATOLOGY INTERNATIONAL
(2023)
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)
Article
Gastroenterology & Hepatology
Bryan D. Badal, Jasmohan S. Bajaj
Summary: The inclusion of acute encephalopathy in all society definitions of acute-on-chronic liver failure (ACLF) highlights its significance in the syndrome. Acute encephalopathy in ACLF is caused by severe inflammation, and it is important to identify reversible causes. Hepatic encephalopathy not only increases mortality in ACLF but also hinders evaluation for liver transplant due to patient instability. Further research is needed to identify at-risk individuals, develop better prognostic tools, and explore novel treatments. Optimal ICU care, palliative care services, and patient satisfaction should be considered in managing encephalopathic patients.
CLINICS IN LIVER DISEASE
(2023)
Article
Immunology
Fabricio Sevilla-Acosta, Alfonso Gutierrez-Mata, Adriana Yock-Corrales, Sixto Bogantes-Ledezma, Cristian Perez-Corrales, Kattia Camacho-Badilla
Summary: Limited data on childhood encephalitis in Latin America prompted a study in Costa Rica to examine clinical presentation, etiology, and outcomes in pediatric patients. The study revealed diverse etiologies, with enterovirus and Streptococcus pneumoniae being common culprits and a significant morbidity and mortality rate associated with acute encephalitis. Early and aggressive treatment with antivirals, antibiotics, and anticerebral edema measures was found to be crucial for improving outcomes in children with acute encephalitis.
PEDIATRIC INFECTIOUS DISEASE JOURNAL
(2021)
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
Multidisciplinary Sciences
Nese Colak, Ozlem Bayrak Basakci, Basak Bayram, Ersin Aksay, Muhammet Kursat Simsek, Nuri Karabay
Summary: This study found that the optic nerve sheath diameter (ONSD) increases in patients with hepatic encephalopathy (HE). However, ONSD is not related to the Child-Pugh Score, HE grade, and in-hospital mortality.
Article
Medicine, Research & Experimental
Jun Weng, Xu Han, Fanhong Zeng, Yue Zhang, Lei Feng, Lei Cai, Kangyan Liang, Shusong Liu, Shao Li, Gongbo Fu, Min Zeng, Yi Gao
Summary: The study utilized a fiber scaffold bioreactor for high-density, 3D culture of porcine hepatocytes to construct a bioartificial liver and evaluated its protective effects in an ALF porcine model. The bioartificial liver treatment enhanced liver regeneration, alleviated systemic inflammatory response, and reduced extrahepatic organ injury, leading to prolonged survival in the ALF model.
Article
Immunology
Wouter Claeys, Lien Van Hoecke, Hannah Lernout, Clint De Nolf, Griet Van Imschoot, Elien Van Wonterghem, Daan Verhaege, Jonas Castelein, Anja Geerts, Christophe Van Steenkiste, Roosmarijn E. Vandenbroucke
Summary: Hepatic encephalopathy, a complication of liver cirrhosis, lacks brain-targeted therapies. Astrocytes and microglia have been implicated in its development. RNA-Seq analysis of sorted astrocytes and microglia in a mouse model of hepatic encephalopathy revealed transcriptional responses, particularly in microglia, enriched in inflammation and hypoxia pathways. Astrocytes showed increased corticoid receptor and oxidative stress signaling, while microglial transcriptome changes were linked to immune cell attraction. This study provides insights into the molecular mechanisms of hepatic encephalopathy and potential glial-directed therapeutic strategies.
JOURNAL OF NEUROINFLAMMATION
(2023)
Review
Medicine, General & Internal
Piero Amodio, Sara Montagnese
Summary: Hepatic encephalopathy is a form of brain dysfunction caused by liver insufficiency and/or portal-systemic shunting, with inconsistencies in its detection and management. Diagnosis of HE involves consideration of its phenotypes, risk factors, and differential diagnosis from other similar conditions.
JOURNAL OF CLINICAL MEDICINE
(2021)
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)
Review
Medicine, General & Internal
Chiara Mangini, Sara Montagnese
Summary: Hepatic encephalopathy (HE) is a common complication of advanced liver disease with significant implications for patients, families, healthcare services, and society as a whole. The past few years have seen increased attention towards HE and the development of new drugs/management strategies to address this serious management challenge.
JOURNAL OF CLINICAL MEDICINE
(2021)