Direct acting inhibitors of ammoniagenesis: a role in post-TIPS encephalopathy?
Journal Title: Annals of Hepatology - Year 2014, Vol 13, Issue 2
Abstract
A limited number of medications are typically considered for the management of hepatic encephalopathy occurring as a complication of transjugular intrahepatic portosystemic shunt (TIPS) placement. Multiple alternative compounds aimed at disrupting ammoniagenesis are or will soon be available, though their use tends to be limited by a lack of large data sets and of clinical awareness. In this review, we provide a targeted overview of the mechanisms and availability of five anti-ammoniagenic compounds (sodium phenylbutyrate, glycerol phenylbutyrate, sodium benzoate, L-ornithine L-aspartate, and ornithine phenylacetate) identified as possibly useful alternative therapeutic agents for cirrhotic encephalopathy. Three of these medications have been FDA approved for use in congenital urea cycle disorders only, while two are under active investigation for use in cirrhotic patients. In spite of limitations posed by cost and comorbidities, familiarity with these options may prove beneficial in cases refractory to conventional management.
Authors and Affiliations
Nitin K. Ahuja Ahuja, Winston A. Ally, Stephen H. Caldwell
Keywords
Related Articles
- EP ID EP78373
- DOI -
- Views 134
- Downloads 0
Evidence-Based Medicine and the Problem of Healthy Volunteers
Healthy controls are subjects without the disease being studied but may have other conditions indirectly affecting outcome. In the present epidemics of obesity a few subjects with undiagnosed nonalcoholic fatty liver dis...
Hemorrhagic liver cyst rupture: An unusual life-threatening complication of hepatic cyst and literature review
[b]Background & aims[/b]. Hemorrhagic rupture is an extremely rare complication of hepatic cyst. Its incidence, gravity and treatment modalities are inadequately covered in the literature. [b]Material and met...
Thrombosis of the Portal Venous System in Cirrhotic vs. Non-Cirrhotic Patients
Introduction and aim. Thrombosis is a vascular disorder of the liver often associated with significant morbidity and mortality. Cirrhosis is a predisposing factor for portal venous system thrombosis. The aim of this stud...
Promotor methylation: Does it affect response to therapy in chronic Hepatitis C (G4) or fibrosis?
Background and aim. DNA methylation plays a critical role in the control of important cellular processes. The present study assessed the impact of promoter methylation (PM) of some genes on the antiviral response to anti...
The risk of carcinogenesis in congenital choledochal cyst patients: an analysis of 214 cases
Background. Choledochal cysts are most common in Asian populations. In addition, the incidence of biliary tract malignancies from choledochal cysts is increasing, but the risk of carcinogenesis is still unclear. Material...