Gut microbiota regulation and diet therapy for hepatic encephalopathy

Yingyu LE; Rongzhen ZHANG; Weisong XIAO; Xiaobin QIN; Shenglan ZENG; Dewen MAO

doi:10.3969/j.issn.1001-5256.2021.07.046

Volume 37 Issue 7

Jul. 2021

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Article Navigation > Journal of Clinical Hepatology > 2021 > 37(7): 1694-1698

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Gut microbiota regulation and diet therapy for hepatic encephalopathy

DOI: 10.3969/j.issn.1001-5256.2021.07.046

1.
Graduate School of Guangxi University of Chinese Medicine, Nanning 530222, China
2.
First Department of Hepatology, The First Affiliated Hospital of Guangxi University of Chinese Medicine, Nanning 530023, China

Research funding:

National Natural Science Foundation of China(General Program) (81774236);

National Natural Science Foundation of China (81960841);

Natural Science Foundation of Guangxi (2018GXNSFAA281096);

Guangxi Science and Technology Plan Project - Guangxi Science and Technology Base and Talents Special Project (Guike AD17129001);

Guangxi Postgraduate Education Innovation Program (YCXJ2021038)

Received Date: 2020-12-18
Accepted Date: 2021-02-08
Published Date: 2021-07-20

Abstract

Abstract

Hepatic encephalopathy (HE) greatly increases the economic burden of patients with liver disease and seriously affects their quality of life. HE has a complex pathological basis and various influencing factors, and its pathogenesis has not been fully clarified. There is still no specific effective therapy for this disease, and drug therapy often has an unsatisfactory clinical effect, as many drugs have poor tolerability, low compliance, and common adverse effects. This article analyzes and summarizes the non-drug therapies for hepatic encephalopathy including protein food and gut microbiota regulation, in order to provide new ideas and high-quality regimens for clinical treatment.
- Hepatic Encephalopathy,
- Gastrointestinal Microbiome,
- Healthy Diet,
- Therapeutics

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References(51)

References

[1]	American Association for the Study of Liver Diseases; European Association for the Study of the Liver. Hepatic encephalopathy in chronic liver disease: 2014 practice guideline by the European Association for the Study of the Liver and the American Association for the Study of Liver Diseases[J]. J Hepatol, 2014, 61(3): 642-659. DOI: 10.1016/j.jhep.2014.05.042.
[2]	RIDOLA L, CARDINALE V, RIGGIO O. The burden of minimal hepatic encephalopathy: From diagnosis to therapeutic strategies[J]. Ann Gastroenterol, 2018, 31(2): 151-164. DOI: 10.20524/aog.2018.0232.
[3]	RIDOLA L, NARDELLI S, GIOIA S, et al. Quality of life in patients with minimal hepatic encephalopathy[J]. World J Gastroenterol, 2018, 24(48): 5446-5453. DOI: 10.3748/wjg.v24.i48.5446.
[4]	ZHANG JC, WANG YG, LIN F, et al. The pathogenesis of hepatic encephalopathy[J/CD]. Chin J Liver Dis (Electronic Version), 2019, 11(1): 6-11. DOI: 10.3969/j.issn.1674-7380.2019.01.002. 张军昌, 王永刚, 林芳, 等. 肝性脑病发病机制新进展[J/CD]. 中国肝脏病杂志(电子版), 2019, 11(1): 6-11. DOI: 10.3969/j.issn.1674-7380.2019.01.002.
[5]	YAN ML, ZHANG Z, QIN YP, et al. progress of drug therapy for hepatic encephalopathy[J]. Tianjin Pharmacy, 2019, 31(3): 55-59. DOI: 10.3969/j.issn.1006-5687.2019.03.019. 闫美玲, 张正, 秦寅鹏, 等. 肝性脑病的药物治疗研究进展[J]. 天津药学, 2019, 31(3): 55-59. DOI: 10.3969/j.issn.1006-5687.2019.03.019.
[6]	JAWARO T, YANG A, DIXIT D, et al. Management of hepatic encephalopathy: A primer[J]. Ann Pharmacother, 2016, 50(7): 569-577. DOI: 10.1177/1060028016645826.
[7]	SHARMA P, SHARMA BC. Lactulose for minimal hepatic encephalopathy in patients with extrahepatic portal vein obstruction[J]. Saudi J Gastroenterol, 2012, 18(3): 168-172. DOI: 10.4103/1319-3767.96448.
[8]	European Association for the Study of the Liver. EASL clinical practice guidelines on nutrition in chronic liver disease[J]. J Hepatol, 2019, 70(1): 172-193. DOI: 10.1016/j.jhep.2018.06.024.
[9]	PLAUTH M, BERNAL W, DASARATHY S, et al. ESPEN guideline on clinical nutrition in liver disease[J]. Clin Nutr, 2019, 38(2): 485-521. DOI: 10.1016/j.clnu.2018.12.022.
[10]	PEARLMAN M, AKPOTAIRE O. Diet and the role of food in common gastrointestinal diseases[J]. Med Clin North Am, 2019, 103(1): 101-110. DOI: 10.1016/j.mcna.2018.08.008.
[11]	SUMMERSKILL WH, WOLFE SJ, DAVIDSON CS. The management of hepatic coma in relation to protein withdrawal and certain specific measures[J]. Am J Med, 1957, 23(1): 59-76. DOI: 10.1016/0002-9343(57)90358-3.
[12]	CÓRDOBA J, LÓPEZ-HELLÍN J, PLANAS M, et al. Normal protein diet for episodic hepatic encephalopathy: Results of a randomized study[J]. J Hepatol, 2004, 41(1): 38-43. DOI: 10.1016/j.jhep.2004.03.023.
[13]	FENTON JC, KNIGHT EJ, HUMPHERSON PL. Milk-and-cheese diet in portal-systemic encephalopathy[J]. Lancet, 1966, 1(7430): 164-166. DOI: 10.1016/s0140-6736(66)90696-9.
[14]	CHATAURET N, DESJARDINS P, ZWINGMANN C, et al. Direct molecular and spectroscopic evidence for increased ammonia removal capacity of skeletal muscle in acute liver failure[J]. J Hepatol, 2006, 44(6): 1083-1088. DOI: 10.1016/j.jhep.2005.11.048.
[15]	CLEMMESEN JO, KONDRUP J, OTT P. Splanchnic and leg exchange of amino acids and ammonia in acute liver failure[J]. Gastroenterology, 2000, 118(6): 1131-1139. DOI: 10.1016/s0016-5085(00)70366-0.
[16]	KAWAGUCHI T, TANIGUCHI E, SATA M. Effects of oral branched-chain amino acids on hepatic encephalopathy and outcome in patients with liver cirrhosis[J]. Nutr Clin Pract, 2013, 28(5): 580-588. DOI: 10.1177/0884533613496432.
[17]	HOLECEK M. Ammonia and amino acid profiles in liver cirrhosis: Effects of variables leading to hepatic encephalopathy[J]. Nutrition, 2015, 31(1): 14-20. DOI: 10.1016/j.nut.2014.03.016.
[18]	DEJONG CH, van de POLL MC, SOETERS PB, et al. Aromatic amino acid metabolism during liver failure[J]. J Nutr, 2007, 137(6 Suppl 1): 1579s-1585s; discussion 1597S-1598S. DOI: 10.1093/jn/137.6.1579S.
[19]	GLUUD LL, DAM G, BORRE M, et al. Lactulose, rifaximin or branched chain amino acids for hepatic encephalopathy: What is the evidence?[J]. Metab Brain Dis, 2013, 28(2): 221-225. DOI: 10.1007/s11011-012-9372-0.
[20]	LES I, DOVAL E, GARCÍA-MARTÍNEZ R, et al. Effects of branched-chain amino acids supplementation in patients with cirrhosis and a previous episode of hepatic encephalopathy: A randomized study[J]. Am J Gastroenterol, 2011, 106(6): 1081-1088. DOI: 10.1038/ajg.2011.9.
[21]	KIRCHEIS G, LVTH S. Pharmacokinetic and pharmacodynamic properties of L-Ornithine L-Aspartate (LOLA) in hepatic encephalopathy[J]. Drugs, 2019, 79(Suppl 1): 23-29. DOI: 10.1007/s40265-018-1023-2.
[22]	BUTTERWORTH RF, KIRCHEIS G, HILGER N, et al. Efficacy of l-Ornithine l-Aspartate for the treatment of hepatic encephalopathy and hyperammonemia in cirrhosis: Systematic review and meta-analysis of randomized controlled trials[J]. J Clin Exp Hepatol, 2018, 8(3): 301-313. DOI: 10.1016/j.jceh.2018.05.004.
[23]	BUTTERWORTH RF, MCPHAIL M. L-Ornithine L-Aspartate (LOLA) for hepatic encephalopathy in cirrhosis: Results of randomized controlled trials and meta-analyses[J]. Drugs, 2019, 79(Suppl 1): 31-37. DOI: 10.1007/s40265-018-1024-1.
[24]	VARAKANAHALLI S, SHARMA BC, SRIVASTAVA S, et al. Secondary prophylaxis of hepatic encephalopathy in cirrhosis of liver: A double-blind randomized controlled trial of L-ornithine L-aspartate versus placebo[J]. Eur J Gastroenterol Hepatol, 2018, 30(8): 951-958. DOI: 10.1097/MEG.0000000000001137.
[25]	GOH ET, STOKES CS, SIDHU SS, et al. L-ornithine L-aspartate for prevention and treatment of hepatic encephalopathy in people with cirrhosis[J]. Cochrane Database Syst Rev, 2018, 5(5): CD012410. DOI: 10.1002/14651858.CD012410.pub2.
[26]	STRAVITZ RT, GOTTFRIED M, DURKALSKI V, et al. Safety, tolerability, and pharmacokinetics of l-ornithine phenylacetate in patients with acute liver injury/failure and hyperammonemia[J]. Hepatology, 2018, 67(3): 1003-1013. DOI: 10.1002/hep.29621.
[27]	MARTÍNEZ GARCÍA RM, JIMÉNEZ ORTEGA AI, LÓPEZ SOBALER AM, et al. Nutrition strategies that improve cognitive function[J]. Nutr Hosp, 2018, 35(Spec No6): 16-19. DOI: 10.20960/nh.2281.
[28]	PERES WA, CHAVES GV, GONÇALVES JC, et al. Vitamin A deficiency in patients with hepatitis C virus-related chronic liver disease[J]. Br J Nutr, 2011, 106(11): 1724-1731. DOI: 10.1017/S0007114511002145.
[29]	KATAYAMA K, SAITO M, KAWAGUCHI T, et al. Effect of zinc on liver cirrhosis with hyperammonemia: A preliminary randomized, placebo-controlled double-blind trial[J]. Nutrition, 2014, 30(11-12): 1409-1414. DOI: 10.1016/j.nut.2014.04.018.
[30]	GUEVARA M, BACCARO ME, TORRE A, et al. Hyponatremia is a risk factor of hepatic encephalopathy in patients with cirrhosis: A prospective study with time-dependent analysis[J]. Am J Gastroenterol, 2009, 104(6): 1382-1389. DOI: 10.1038/ajg.2009.293.
[31]	SHEN TD. Diet and gut microbiota in health and disease[J]. Nestle Nutr Inst Workshop Ser, 2017, 88: 117-126. DOI: 10.1159/000455220.
[32]	WOODHOUSE CA, PATEL VC, SINGANAYAGAM A, et al. Review article: The gut microbiome as a therapeutic target in the pathogenesis and treatment of chronic liver disease[J]. Aliment Pharmacol Ther, 2018, 47(2): 192-202. DOI: 10.1111/apt.14397.
[33]	GIBSON GR, HUTKINS R, SANDERS ME, et al. Expert consensus document: The International Scientific Association for Probiotics and Prebiotics (ISAPP) consensus statement on the definition and scope of prebiotics[J]. Nat Rev Gastroenterol Hepatol, 2017, 14(8): 491-502. DOI: 10.1038/nrgastro.2017.75.
[34]	PINZONE MR, CELESIA BM, di ROSA M, et al. Microbial translocation in chronic liver diseases[J]. Int J Microbiol, 2012, 2012: 694629. DOI: 10.1155/2012/694629.
[35]	CHEN C, LI L, WU Z, et al. Effects of lactitol on intestinal microflora and plasma endotoxin in patients with chronic viral hepatitis[J]. J Infect, 2007, 54(1): 98-102. DOI: 10.1016/j.jinf.2005.11.013.
[36]	STADLBAUER V, MOOKERJEE RP, HODGES S, et al. Effect of probiotic treatment on deranged neutrophil function and cytokine responses in patients with compensated alcoholic cirrhosis[J]. J Hepatol, 2008, 48(6): 945-951. DOI: 10.1016/j.jhep.2008.02.015.
[37]	LATA J, JURANKOVA J, KOPACOVA M, et al. Probiotics in hepatology[J]. World J Gastroenterol, 2011, 17(24): 2890-2896. DOI: 10.3748/wjg.v17.i24.2890.
[38]	LUNIA MK, SHARMA BC, SHARMA P, et al. Probiotics prevent hepatic encephalopathy in patients with cirrhosis: A randomized controlled trial[J]. Clin Gastroenterol Hepatol, 2014, 12(6): 1003-1008. e1. DOI: 10.1016/j.cgh.2013.11.006.
[39]	DHIMAN RK, RANA B, AGRAWAL S, et al. Probiotic VSL#3 reduces liver disease severity and hospitalization in patients with cirrhosis: A randomized, controlled trial[J]. Gastroenterology, 2014, 147(6): 1327-1337. e3. DOI: 10.1053/j.gastro.2014.08.031.
[40]	CAO Q, YU CB, YANG SG, et al. Effect of probiotic treatment on cirrhotic patients with minimal hepatic encephalopathy: A meta-analysis[J]. Hepatobiliary Pancreat Dis Int, 2018, 17(1): 9-16. DOI: 10.1016/j.hbpd.2018.01.005.
[41]	SAJI S, KUMAR S, THOMAS V. A randomized double blind placebo controlled trial of probiotics in minimal hepatic encephalopathy[J]. Trop Gastroenterol, 2011, 32(2): 128-132.
[42]	LIU Q, DUAN ZP, HA DK, et al. Synbiotic modulation of gut flora: Effect on minimal hepatic encephalopathy in patients with cirrhosis[J]. Hepatology, 2004, 39(5): 1441-1449. DOI: 10.1002/hep.20194.
[43]	BAJAJ JS, SAEIAN K, CHRISTENSEN KM, et al. Probiotic yogurt for the treatment of minimal hepatic encephalopathy[J]. Am J Gastroenterol, 2008, 103(7): 1707-1715. DOI: 10.1111/j.1572-0241.2008.01861.x.
[44]	LIU JE, ZHANG Y, ZHANG J, et al. Probiotic yogurt effects on intestinal flora of patients with chronic liver disease[J]. Nurs Res, 2010, 59(6): 426-432. DOI: 10.1097/NNR.0b013e3181fa4dc6.
[45]	CAMPION D, PONZO P, ALESSANDRIA C, et al. The role of microbiota in autism spectrum disorders[J]. Minerva Gastroenterol Dietol, 2018, 64(4): 333-350. DOI: 10.23736/S1121-421X.18.02493-5.
[46]	PIWOWARCZYK A, HORVATH A, ŁUKASIK J, et al. Gluten- and casein-free diet and autism spectrum disorders in children: A systematic review[J]. Eur J Nutr, 2018, 57(2): 433-440. DOI: 10.1007/s00394-017-1483-2.
[47]	BALZOLA F, SANNA C, OTTOBRELLI A, et al. Chronic hepatic encephalopaty (HE) in patients with severe liver cirrhosis: Efficacy of the wheat and milk protein free diet in the reduction of clinical episodes[J]. J Hepatol, 2011, 54: s64. DOI: 10.1016/S0168-8278(11)60148-7.
[48]	WANG WW, ZHANG Y, HUANG XB, et al. Fecal microbiota transplantation prevents hepatic encephalopathy in rats with carbon tetrachloride-induced acute hepatic dysfunction[J]. World J Gastroenterol, 2017, 23(38): 6983-6994. DOI: 10.3748/wjg.v23.i38.6983.
[49]	BAJAJ JS, KASSAM Z, FAGAN A, et al. Fecal microbiota transplant from a rational stool donor improves hepatic encephalopathy: A randomized clinical trial[J]. Hepatology, 2017, 66(6): 1727-1738. DOI: 10.1002/hep.29306.
[50]	BAJAJ JS, FAGAN A, GAVIS EA, et al. Long-term outcomes of fecal microbiota transplantation in patients with cirrhosis[J]. Gastroenterology, 2019, 156(6): 1921-1923. e3. DOI: 10.1053/j.gastro.2019.01.033.
[51]	DEFILIPP Z, BLOOM PP, TORRES SOTO M, et al. Drug-resistant E. coli bacteremia transmitted by fecal microbiota transplant[J]. N Engl J Med, 2019, 381(21): 2043-2050. DOI: 10.1056/NEJMoa1910437.

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Gut microbiota regulation and diet therapy for hepatic encephalopathy

DOI: 10.3969/j.issn.1001-5256.2021.07.046

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Gut microbiota regulation and diet therapy for hepatic encephalopathy

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