Comparative Study of Branched Chain Amino Acids Infusion with Conventional treatment in patients with Hepatic Encephalopathy due to Liver Cirrhosis

Main Article Content

Mohammad Abdur Rahman Afridi
Aftab Ahmad
Zafar Ali
Javed Iqbal Farooqi
Riaz Mohammad
Intekhab Alam


OBJECTIVE: To determine the effectiveness of branched chain amino
acid (BCAA) infusion with conventional therapy in the treatment of
hepatic encephalopathy (HE) due to liver cirrhosis.

METHODOLOGY: This was a hospital based randomized controlled
trial, conducted in the department of medicine, Lady Reading Hospital,
Peshawar from February 2012 to July 2012.
A total number of 86 patients, of either gender, presenting with grade
II, III and IV HE due to cirrhosis were included in the study. They were
randomly allocated into two groups by lottery method. Forty three
patients in group A were subjected to conventional treatment plus infusion of BCAA (Aminoleban, Otsuka); while 43 patients in group B were
subjected to conventional treatment only, which consisted of antibiotics
and lactulose. Data analysis was performed using SPSS version 20. ‘Chi
square’ test was used to compare the effectiveness in both groups with
p value of < 0.05 as significant.

RESULTS: Out of 86 patients included in the study, 52(60.5%) were
males and 34 (39.5%) were females. Mean age of the sample was
49.73±7.958 years with age range from 35 to 70 years. After the administration of BCAA infusion twice daily for 3 days, clinical improvement was observed in 33 (76.7%) patients in group A while in group B only 10 (23.3%) patients improved clinically, showing p-value <0.001.

CONCLUSION: Branched chain amino acids infusion is more effective
than conventional therapy in the treatment of HE due to liver cirrhosis.

KEY WORDS: Hepatic Encephalopathy, Chronic Liver Disease, Branched Chain Amino acids.

Article Details

How to Cite
Afridi, M. A. R., A. Ahmad, Z. Ali, J. I. Farooqi, R. Mohammad, and I. Alam. “Comparative Study of Branched Chain Amino Acids Infusion With Conventional Treatment in Patients With Hepatic Encephalopathy Due to Liver Cirrhosis”. KHYBER MEDICAL UNIVERSITY JOURNAL, vol. 6, no. 4, Dec. 2014, pp. 163-6,
Original Articles
Author Biographies

Mohammad Abdur Rahman Afridi, Post Graduate Medical Institute, Lady Reading Hospital, Peshawar

Assistant Professor Department of Medicine, PGMI,  LRH PESHAWAR

Intekhab Alam

Professor Department of Medicine, PGMI,  LRH PESHAWAR



V. Hepatic encephalopathy: effects of

liver failure on brain function. Nature Rev

Neurosci 2013; 14: 851-8.

Butterworth RF. Hepatic encephalopathy:

A central neuroinflammatory disorder?

Hepatology 2011; 53(4): 1372-6.

Wright G, Chattree A, Jalan R. Management

of Hepatic Encephalopathy. Int

J Hepatol 2011; Volume 2011 (2011),

Article ID 841407, 10 pages. doi:


Gluud LL, Dam G, Borre M, Les I, Cordoba

J, Marchesini G, Aagaard NK, Vilstrup

H. Lactulose, rifaximin or branched chain

amino acids for hepatic encephalopathy:

what is the evidence? Metab Brain

Dis 2013; 28(2): 221-5.

Häussinger D. Hepatic encephalopathy.

Acta Gastroenterol Belg 2010; 73: 457-64.

Moriwaki H, Shiraki M, Iwasa J, Terakura

Y. Hepatic encephalopathy as complication

of liver cirrhosis: an Asian perspective. J

Gastroenterol Hepatol 2010; 25: 858-63.

Córdoba J, López-Hellín J, Planas M, Sabín

P, Sanpedro F, Castro F, et al. Normal

protein diet for episodic hepatic encephalopathy:

results of a randomized study. J

Hepatol 2004; 41(1): 38-43.

Bass NM. Review article: the current

pharmacological therapies for hepatic

encephalopathy. Aliment Pharmacol Ther

; 25 Suppl 1: 23-31.

Sakai Y, Iwata Y, Enomoto H , Saito M, Yoh

K, Ishii A, et al. Two randomized controlled

studies comparing the nutritional benefits

of branched-chain amino acid (BCAA)

granules and a BCAA-enriched nutrient

mixture for patients with esophageal

varices after endoscopic treatment. J

Gastroenterol 2014; Published online

March 17. DOI 10.1007/s00535-


Soomro A A, Devrajani B R, Ghori R A, Lohana

H and Qureshi G A. Role of Branched

Chain Amino Acids in the Management of

Hepatic Encephalopathy. World J Med Sci

; 3 (2): 60-4.

Gluud LL, Dam G, Borre M, Les I, Cordoba

J, Marchesini G, et al. Oral branchedchain

amino acids have a beneficial effect

on manifestations of hepatic encephalopathy

in a systematic review with meta-analyses

of randomized controlled trials. J Nutr

; 143(8): 1263-8.

Kachaamy T, Bajaj JS. Diet and cognition in

chronic liver disease. Curr Opin Gastroenterol

; 27: 174-9.

Chadalavada R, Sappati Biyyani RS, Maxwell

J, Mullen K. Nutrition in hepatic

Encephalopathy. Nutr Clin Pract 2010;

: 257-64.

Plauth M, Schütz T. Branched-chain amino

acids in liver disease: new aspects of long

known phenomena. Curr Opin Clin Nutr

Metab Care 2011; 14(1): 61-6.

Kawaguchi T, Taniguchi E, Sata M. Effects

of oral branched-chain amino acids on hepatic

encephalopathy and outcome in

patients with liver cirrhosis. Nutr Clin

Pract. 2013; 28(5): 580-8.

Holecek M. Three targets of branchedchain

amino acid supplementation in the

treatment of liver disease. Nutrition 2010;

: 482-90.

Schulz GJ, Campos AC, Coelho JC. The

role of nutrition in hepatic encephalopathy.

Curr Opin Clin Nutr Metab Care 2008;

: 275-80.

Afzal S, Ahmad M. Role of branched chain

amino acids in reversal of hepatic encephalopathy.

Ann King Edward Med Uni 2010;

: 108-11.

Ichikawa T, Naota T, Miyaaki H, Miuma S,

Isomoto H, Takeshima, F et al. Effect of an

oral branched chain amino acid-enriched

snack in cirrhotic patients with sleep disturbance.

Hepatol Res 2010; 40: 971-8.

Khanna S, Gopalan S. Role of branchedchain

amino acids in liver disease: the

evidence for and against. Curr Opin Clin

Nutr Metab Care 2007; 10: 297-303.

Als-Nielsen B, Koretz RL, Gluud LL, Gluud

C. Branched-chain amino acids for hepatic

encephalopathy. Cochrane Database of

Systematic Reviews 2003, Issue 1. Art.

No.: CD001939. DOI: 10.1002/14651858.


Atiq M, Gill ML. Quality of life assessment

in Pakistani Patients with Chronic Liver

Disease. J Pak Med Assoc 2004; 54 (3):


Lauer GM, Walker BD. Hepatitis C Virus

infection. N Engl J Med 2001; 345: 41-52.

Lewling H, Breitkreutz R, Behne F, Staedt

U, Striebel JR, Holm E. Hyperammonia

induced depletion of glutamate and

branched chain aminoacids in muscle and

plasma. J Hepatol 1996; 25: 756-62.

Tangkijvanich P, Mahachai V, Wittayalertpanya

S, Ari-yawongsopon V, Isarasena S.

Short term effects of branched chain amino

acids on liver function tests in cirrhotic

patients. Southeast Asian J Trop Med Public

Health 2000; 31 (1): 152-7.

Suzuki K, Kato A, Iwai M. Branched chain

amino acid treatment in the patients with

liver cirrhosis. Hepatol Res 2004; 30: 25-9.

Metcalfe EL, Avenell A, Fraser A.

Branched-chain amino acid supplementation

in adults with cirrhosis and porto-systemic

encephalopathy: Systematic review.

Clin Nutr 2014; S0261-5614(14)00073-9.

Bak LK, Waagepetersen HS, Sørensen

M, Ott P, Vilstrup H, Keiding S, et al. Role

of branched chain amino acids in cerebral

ammonia homeostasis related to hepatic

encephalopathy. Metab Brain Dis 2013;

(2): 209-15.

Tajiri K, Shimizu Y. Branched-chain amino

acids in liver diseases. World J Gastroenterol.

; 19(43): 7620-9.

Les I, Doval E, García-Martínez R, Planas

M, Cárdenas G, Gómez P, et al. Effects

of branched-chain amino acids supplementation

in patients with cirrhosis and a

previous episode of hepatic encephalopathy:

a randomized study. Am J Gastroenterol

; 106(6): 1081-8.

Fabbri A, Magrini N, Bianchi G, Zoli M,

Marchesini G. Overview of Randomized

Clinical Trials of Oral Branched-Chain

Amino Acid Treatment in Chronic Hepatic

Encephalopathy. J Parenter Enteral Nutr

; 20 (2): 159-64.