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.
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;
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;
Schulz GJ, Campos AC, Coelho JC. The
role of nutrition in hepatic encephalopathy.
Curr Opin Clin Nutr Metab Care 2008;
Afzal S, Ahmad M. Role of branched chain
amino acids in reversal of hepatic encephalopathy.
Ann King Edward Med Uni 2010;
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;
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.
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