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The role of antioxidants and zinc in minimal hepatic encephalopathy: a randomized trial.

Abstract

BACKGROUND

Minimal hepatic encephalopathy (MHE) has a far-reaching impact on quality and function ability in daily life and may progress to overt hepatic encephalopathy. There is a synergistic effect between systemic oxidative stress and ammonia that is implicated in the pathogenesis of hepatic encephalopathy. The aim of this study is to investigate the effectiveness of oral supplementation of antioxidants and zinc gluconate on MHE versus lactulose.

METHODS

Our study included 58 patients with cirrhosis diagnosed as having MHE by neuropsychometric tests, including number connection test part A (NCT-A), digit symbol test (DST) and block design tests (BDTs). Patients were randomized to receive 175 mg zinc gluconate, 50,000 IU vitamin A, 500 mg vitamin C and 100 mg vitamin E once daily plus lactulose, dose 30-60 ml/day for 3 months [group A (n = 31)] or initiated and maintained on lactulose dose 30-60 ml/day for 3 months [group B (n = 27)]. Neuropsychometric tests and laboratory investigations were repeated after 3 months of therapy.

RESULTS

Compared with the baseline neuropsychometric tests, a significant improvement was reported in patients with MHE after 3 months of antioxidant and zinc therapy (group A) versus patients with lactulose therapy (group B) (NCT-A, p <0.001; DST, p = 0.006; BDT, p < 0.001). Antioxidant and zinc supplementation significantly decreased arterial ammonia level, alanine aminotransferase (ALT), aspartate aminotransferase (AST) (p < 0.001) and improved Child-Pugh score in MHE after 3 months of therapy (p= 0.024).

CONCLUSION

Antioxidant and zinc supplementation can improve MHE in patients with liver cirrhosis.

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  • Authors+Show Affiliations

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    Tropical Medicine Department, Faculty of Medicine, Mansoura University, 35516 Mansoura, Egypt.

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    Department of Tropical Medicine, Faculty of Medicine, Mansoura University, Mansoura City, Egypt.

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    Department of Neurology, Faculty of Medicine, Mansoura University, Mansoura City, Egypt.

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    Department of Internal Medicine, Faculty of Medicine, Mansoura University, Mansoura City, Egypt.

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    Department of Internal Medicine, Faculty of Medicine, Mansoura University, Mansoura City, Egypt.

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    Department of Clinical Pathology, Faculty of Medicine, Mansoura University, Mansoura City, Egypt.

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    Endemic Diseases and Gastroenterology Department, Aswan University, Aswan, Egypt.

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    Department of Clinical Pathology, Faculty of Medicine, Mansoura University, Mansoura City, Egypt.

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    Department of Internal Medicine, Faculty of Medicine, Aswan University, Aswan, Egypt.

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    Department of Medical Microbiology and Immunology, Faculty of Medicine, Mansoura University, Mansoura City, Egypt.

    Department of Medical Microbiology and Immunology, Faculty of Medicine, Mansoura University, Mansoura City, Egypt.

    Source

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    27582881

    Citation

    Mousa, Nasser, et al. "The Role of Antioxidants and Zinc in Minimal Hepatic Encephalopathy: a Randomized Trial." Therapeutic Advances in Gastroenterology, vol. 9, no. 5, 2016, pp. 684-91.
    Mousa N, Abdel-Razik A, Zaher A, et al. The role of antioxidants and zinc in minimal hepatic encephalopathy: a randomized trial. Therap Adv Gastroenterol. 2016;9(5):684-91.
    Mousa, N., Abdel-Razik, A., Zaher, A., Hamed, M., Shiha, G., Effat, N., ... Eldars, W. (2016). The role of antioxidants and zinc in minimal hepatic encephalopathy: a randomized trial. Therapeutic Advances in Gastroenterology, 9(5), pp. 684-91. doi:10.1177/1756283X16645049.
    Mousa N, et al. The Role of Antioxidants and Zinc in Minimal Hepatic Encephalopathy: a Randomized Trial. Therap Adv Gastroenterol. 2016;9(5):684-91. PubMed PMID: 27582881.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - The role of antioxidants and zinc in minimal hepatic encephalopathy: a randomized trial. AU - Mousa,Nasser, AU - Abdel-Razik,Ahmed, AU - Zaher,Ashraf, AU - Hamed,Magdy, AU - Shiha,Gamal, AU - Effat,Narmin, AU - Elbaz,Sherif, AU - Elhelaly,Rania, AU - Hafez,Mohamed, AU - El-Wakeel,Niveen, AU - Eldars,Waleed, Y1 - 2016/05/01/ PY - 2016/9/2/entrez PY - 2016/9/2/pubmed PY - 2016/9/2/medline KW - antioxidants KW - minimal hepatic encephalopathy KW - zinc SP - 684 EP - 91 JF - Therapeutic advances in gastroenterology JO - Therap Adv Gastroenterol VL - 9 IS - 5 N2 - BACKGROUND: Minimal hepatic encephalopathy (MHE) has a far-reaching impact on quality and function ability in daily life and may progress to overt hepatic encephalopathy. There is a synergistic effect between systemic oxidative stress and ammonia that is implicated in the pathogenesis of hepatic encephalopathy. The aim of this study is to investigate the effectiveness of oral supplementation of antioxidants and zinc gluconate on MHE versus lactulose. METHODS: Our study included 58 patients with cirrhosis diagnosed as having MHE by neuropsychometric tests, including number connection test part A (NCT-A), digit symbol test (DST) and block design tests (BDTs). Patients were randomized to receive 175 mg zinc gluconate, 50,000 IU vitamin A, 500 mg vitamin C and 100 mg vitamin E once daily plus lactulose, dose 30-60 ml/day for 3 months [group A (n = 31)] or initiated and maintained on lactulose dose 30-60 ml/day for 3 months [group B (n = 27)]. Neuropsychometric tests and laboratory investigations were repeated after 3 months of therapy. RESULTS: Compared with the baseline neuropsychometric tests, a significant improvement was reported in patients with MHE after 3 months of antioxidant and zinc therapy (group A) versus patients with lactulose therapy (group B) (NCT-A, p <0.001; DST, p = 0.006; BDT, p < 0.001). Antioxidant and zinc supplementation significantly decreased arterial ammonia level, alanine aminotransferase (ALT), aspartate aminotransferase (AST) (p < 0.001) and improved Child-Pugh score in MHE after 3 months of therapy (p= 0.024). CONCLUSION: Antioxidant and zinc supplementation can improve MHE in patients with liver cirrhosis. SN - 1756-283X UR - https://www.unboundmedicine.com/medline/citation/27582881/The_role_of_antioxidants_and_zinc_in_minimal_hepatic_encephalopathy:_a_randomized_trial_ L2 - http://journals.sagepub.com/doi/full/10.1177/1756283X16645049?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -