A double blind randomized controlled trial to assess efficacy of nutritional therapy for prevention of recurrence of hepatic encephalopathy in patients with cirrhosis

被引:6
作者
Ahuja, Hardik [1 ]
Sharma, Barjesh Chander [1 ,4 ]
Sachdeva, Sanjeev [1 ]
Mahajan, Bhawna [2 ]
Sharma, Ashok [3 ]
Bara, Sushma [1 ]
Srivastava, Siddharth [1 ]
Kumar, Ajay [1 ]
Dalal, Ashok [1 ]
Sonika, Ujjwal [1 ]
机构
[1] GB Pant Hosp, Dept Gastroenterol, New Delhi, India
[2] GB Pant Hosp, Dept Biochem, New Delhi, India
[3] GB Pant Hosp, Dept Radiol, New Delhi, India
[4] GB Pant Hosp, Dept Gastroenterol, Room 201,Acad Block, New Delhi 110002, India
关键词
cirrhosis; hepatic encephalopathy; nutrition; LIVER-CIRRHOSIS; SECONDARY PROPHYLAXIS; OPEN-LABEL; MANAGEMENT; METABOLISM; LACTULOSE; MUSCLE; OVERT;
D O I
10.1111/jgh.16096
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Background and AimOvert hepatic encephalopathy (OHE) has high risk of recurrence and is associated with poor survival. The role of nutrition therapy is well documented in cirrhosis, but its efficacy in preventing the recurrence of OHE has not been studied. MethodsIn double blind RCT, we randomly assigned 150 patients with liver cirrhosis, with history of OHE in recent past to receive nutrition therapy (group I) or no nutrition therapy (group II) and followed up for 6 months. The primary efficacy end points were occurrence of breakthrough episodes and time to breakthrough episode of OHE. Secondary end points were OHE related hospitalizations and time to hospitalization involving OHE. Other parameters included anthropometry, changes in serum cytokines (IL-1, IL-6, IL-10, and TNF-alpha), endotoxin and myostatin. ResultsThere was significant reduction in occurrence of breakthrough episodes of OHE in group I [10 vs 36, hazard ratio 0.20; P < 0.001], OHE-related hospitalization [8 vs 24, hazard ratio 0.27; P < 0.001)]. Times to breakthrough episode of OHE and OHE-related hospitalization were longer in group I. At the end of 6 months, inflammatory and anthropometry parameters showed significant improvement in group I compared with worsening of serum albumin, anthropometric parameters, IL-6, IL-10 and TNF-alpha in group II. At the end of 6 months, ascites (50 vs 66, P = 0.01), gastrointestinal bleed (2 vs 11, P = 0.007), and jaundice (16 vs 41, P < 0.001) were lower in group I. ConclusionsTreatment with nutrition therapy prevented recurrence of OHE and decreased OHE-related hospitalizations as compared with no nutrition therapy.
引用
收藏
页码:433 / 440
页数:8
相关论文
共 31 条
[1]   Secondary Prophylaxis of Hepatic Encephalopathy in Cirrhosis: An Open-Label, Randomized Controlled Trial of Lactulose, Probiotics, and No Therapy [J].
Agrawal, Amit ;
Sharma, Barjesh Chander ;
Sharma, Praveen ;
Sarin, Shiv Kumar .
AMERICAN JOURNAL OF GASTROENTEROLOGY, 2012, 107 (07) :1043-1050
[2]   Comparison between handgrip strength, subjective global assessment, and prognostic nutritional index in assessing malnutrition and predicting clinical outcome in cirrhotic outpatients [J].
Alvares-da-Silva, MR ;
da Silveira, TR .
NUTRITION, 2005, 21 (02) :113-117
[3]  
Amer Assoc Study Liver Dis, 2014, J HEPATOL, V61, P642, DOI 10.1016/j.jhep.2014.05.042
[4]   The Nutritional Management of Hepatic Encephalopathy in Patients With Cirrhosis: International Society for Hepatic Encephalopathy and Nitrogen Metabolism Consensus [J].
Amodio, Piero ;
Bemeur, Chantal ;
Butterworth, Roger ;
Cordoba, Juan ;
Kato, Akinobu ;
Montagnese, Sara ;
Uribe, Misael ;
Vilstrup, Hendrik ;
Morgan, Marsha Y. .
HEPATOLOGY, 2013, 58 (01) :325-336
[5]  
Anand AC, 2017, J CLIN EXP HEPATOL, V7, P340, DOI 10.1016/j.jceh.2017.11.001
[6]   Linkage of gut microbiome with cognition in hepatic encephalopathy [J].
Bajaj, Jasmohan S. ;
Ridlon, Jason M. ;
Hylemon, Phillip B. ;
Thacker, Leroy R. ;
Heuman, Douglas M. ;
Smith, Sean ;
Sikaroodi, Masoumeh ;
Gillevet, Patrick M. .
AMERICAN JOURNAL OF PHYSIOLOGY-GASTROINTESTINAL AND LIVER PHYSIOLOGY, 2012, 302 (01) :G168-G175
[7]   Rifaximin Treatment in Hepatic Encephalopathy [J].
Bass, Nathan M. ;
Mullen, Kevin D. ;
Sanyal, Arun ;
Poordad, Fred ;
Neff, Guy ;
Leevy, Carroll B. ;
Sigal, Samuel ;
Sheikh, Muhammad Y. ;
Beavers, Kimberly ;
Frederick, Todd ;
Teperman, Lewis ;
Hillebrand, Donald ;
Huang, Shirley ;
Merchant, Kunal ;
Shaw, Audrey ;
Bortey, Enoch ;
Forbes, William P. .
NEW ENGLAND JOURNAL OF MEDICINE, 2010, 362 (12) :1071-1081
[8]  
Calmet Fernando, 2019, Gastroenterol Hepatol (N Y), V15, P248
[9]   Probiotic VSL#3 Reduces Liver Disease Severity and Hospitalization in Patients With Cirrhosis: A Randomized, Controlled Trial [J].
Dhiman, Radha K. ;
Rana, Baldev ;
Agrawal, Swastik ;
Garg, Ashish ;
Chopra, Madhu ;
Thumburu, Kiran K. ;
Khattri, Amit ;
Malhotra, Samir ;
Duseja, Ajay ;
Chawla, Yogesh K. .
GASTROENTEROLOGY, 2014, 147 (06) :1327-+
[10]   Sarcopenic obesity in cirrhosisThe confluence of 2 prognostic titans [J].
Eslamparast, Tannaz ;
Montano-Loza, Aldo J. ;
Raman, Maitreyi ;
Tandon, Puneeta .
LIVER INTERNATIONAL, 2018, 38 (10) :1706-1717