Fecal transplantation of bacteria from one healthy donor into patients that suffer from hepatic encephalopathy, is safe and improves cognitive function compared with standard of care treatment for the condition, new research concludes. The study results also demonstrated that the number of hospitalizations following fecal transplantation plus antibiotics was two, compared to the standard of care arm, which was 11.
Rifaximin 400 mg 3 times daily is a newer nonabsorbable antibiotic that, according to 2 meta-analyses, is at least as effective as nonabsorbable disaccharides for the treatment of hepatic encephalopathy but with a lower incidence of abdominal pain (P = .04) and fewer hospitalizations. A third meta-analysis found rifaximin to be more effective than lactulose in the treatment of hepatic encephalopathy.
With more advanced hepatic encephalopathy, fatigue, and at least mild deficits of memory, concentration, and coordination may become apparent. At this stage, common complaints by the patient include:
- “I feel like my head is in the clouds.”
- “I’ll walk into a room and forget why I am there.”
- “I am always tired…but I can’t sleep.”
- “I often forget what to say in mid-sentence.”
- “My boss is telling me that my work is slipping.
, number connection tests, etc.). With more advanced hepatic encephalopathy, fatigue, and at least mild deficits of memory, concentration, and coordination may become apparent. At this stage, common complaints by the patient include:
- “I feel like my head is in the clouds.”
- “I’ll walk into a room and forget why I am there.”
- “I am always tired…but I can’t sleep.”
- “I often forget what to say in mid-sentence.”
- “My boss is telling me that my work is slipping.
Low serum sodium (hyponatremia) and potassium (hypokalemia) are common in cirrhotic patients treated with diuretics and both can worsen hepatic encephalopathy. Hypokalemia appears to exacerbate encephalopathy in part by stimulating ammonia production from the kidneys.
• Constipation: Slow transit of stool through the gut appears to increase the time for bacteria digest foodstuffs and make ammonia and other toxins, potentially triggering hepatic encephalopathy.
procedure, she started showing signs of hepatic encephalopathy. She is currently on a list for a liver transplant and was admitted to the hospital today due to a fever. There have been a plethora of other complications she has endured over the years that I won’t get into since I feel they are not relevant to my query here.
Initially we were told that it is possible to treat the encephalopathy with meds and diet. She has not been put on meds for this yet.
I have both hepatitis C and cirrhosis of the liver and have had hepatic encephalopathy attacks averaging one per month, always resulting in loss of consciosness for 48 hrs, (2 days) at a time. It is treated with lactalose (total of ten tablespoons daily). My doctor, Dr. Martin Black,of Temple university Hospital in Philadelphia, has suggested two medicines that will prevent me from "passing out". Is there such a thing?
Hi, it is rare a post is simply left with no response however this one is fairly complicated and perhaps outside the experience of most of us with Hepatitis C.
Fear not though as there are a few very knowledgeable members who might be able to somehow find a way to respond.
I figured I would help this along by providing a few links. I am certain you have done much research already but I found reading about the TIPS procedure quite interesting.
http://health.nytimes.
The semisynthetic, nonsystemic antibiotic, rifaximin, was approved in March 2010 by the United States Food and Drug Administration for the treatment of overt hepatic encephalopathy. Rifaximin decreases intestinal production and absorption of ammonia by altering gastrointestinal flora and is almost completely excreted unchanged in the feces. Rifaximin has been effective in improving behavioral, laboratory, mental, and intellectual abnormalities in patients with hepatic encephalopathy.
His MELD score has remained so low that he has not yet been evaluated for a transplant, however his symptoms including chronic pain and Hepatic Encephalopathy have required him to leave his job and go on disability. The biggest stress on our marriage is his Encephalopathy. He takes lactose on a daily basis, but he is still plagued with issues of poor coordination, memory loss, confusion, mood swings, ect. I came to the group for some support in regard to this issue.
In some cases, the effects of hepatic encephalopathy start slowly and then get worse bit by bit. But sometimes they hit you hard all at once.
There are some mental signs to watch out for.
* Grade 0 - Minimal hepatic encephalopathy (previously known as subclinical hepatic encephalopathy). Lack of detectable changes in personality or behavior. Minimal changes in memory, concentration, intellectual function, and coordination. Asterixis is absent.
* Grade 1 - Trivial lack of awareness. Shortened attention span. Impaired addition or subtraction. Hypersomnia, insomnia, or inversion of sleep pattern. Euphoria, depression, or irritability. Mild confusion.
* Note that the gastrointestinal tract is the primary source of ammonia, the presumed mediator of hepatic encephalopathy, and rifaximin is thought to lower blood ammonia levels by reducing ammonia production and absorption.
Minimal encephalopathy does not lead to overt cognitive dysfunction, but can be shown to exist with neuropsychological tests. It impairs quality of life and has been shown to increase the risk of traffic accidents.
Abnormal movements or shaking of hands or arms
Agitation, excitement, or seizures (occur rarely)
Disorientation
Drowsiness or confusion
Inappropriate behavior or severe personality changes
Slurred speech
Slowed or sluggish movement
Patients with hepatic encephalopathy can become unconscious, unresponsive, and possibly enter a coma.
Patients with hepatic encephalopathy are often not able to care for themselves because of these symptoms.
If you have decompensated cirrhosis, with elevated ammonia levels and hepatic encephalopathy I have see many patients say they have been prescribed Lactulose http://www.nlm.nih.gov/medlineplus/druginfo/meds/a682338.html
But you definitely need to have this conversation with your liver specialist .
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