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Effect of L-ornithine-L-aspartate on patients with and without
TIPS undergoing glutamine challenge: a double blind, placebo controlled
trial.
Rees CJ, Oppong K, Al Mardini H, et al. Gut 2000; 47: 571-4
Centre for Liver Research, University of Newcastle Upon Tyne, Newcastle Upon Tyne, UK.
BACKGROUND
AND AIM: An oral glutamine load in cirrhotic patients awaiting liver
transplantation was shown to cause a rinse in blood ammonia and
psychometric abnormalities which were reversed by hepatic
transplantation. L-Ornithine-L-aspartate (LOLA) has been shown to reduce
ammonia and improve psychometric function in patients with hepatic
encephalopathy. The aim of the present study was to assess the effect of
LOLA in healthy patients with cirrhosis and no evidence of clinical
encephalopathy after challenging the central nervous system by
administration of oral glutamine.
PATIENTS AND METHODS: Eight
cirrhotics (Child´s B or C) without transjugular intrahepatic
portosystemic shunts (TIPS) and seven with TIPS underwent two oral
glutamine (20 g) challenges, receiving LOLA (5 g intravenously) on one
occasion and placebo on the other in random order. Psychometric tests,
including choice reaction time (CRT) and number connection test, were
performed before and after glutamine, together with
electroencephalography and blood ammonia.
RESULTS: Mean basal ammonia
was 27 (SEM 5) micromol/l in non-TIPS and 76 (10) micromol/l in TIPS
patients (p<0.05). Basal CRT 2 was 0.643 (0.033) s in non-TIPS and
0.825 (0.076) s in TIPS patients (p<0.02). In non-TIPS patients,
ammonia increased to 36 (10) micromol/l when LOLA was administered and
to 62 (13) micromol/l with placebo (p<0.02). There was no alteration
in psychometric function in non-TIPS patients after glutamine when LOLA
was given but when placebo was given, glutamine caused prolongation of
CRT (p=0.02). Glutamine did not affect psychometric function in TIPS
patients with or without LOLA.
CONCLUSIONS: This study showed that
LOLA ameliorated the deleterious psychometric effects of glutamine in
Child´s grade B and C patients with cirrhosis without TIPS and supports
its use in clinical practice in hepatic encephalopathy.
Die Therapie mit L-Ornithin-L-Aspartat (LOLA) ist derzeit eine der wenigen in prospektiven randomisierten Studien nachgewiesen wirksamen Therapieformen für die hepatische Enzephalopathie (HE) bei Patienten mit Leberzirrhose und stellt neben der Lactulosebehandlung den Therapiestandard bei diesen Patienten dar. Die HE stellt mit einer Inzidenz von bis zu 30% eine der zwei wichtigsten Probleme der Implantation eines transjugulären intrahepatischen portosystemischen Shunts (TIPS) dar. Zur Therapie der HE nach TIPS liegen bisher keine prospektiven Studien vor.
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Tags: intensiv-news hepatologie leberzirrhose hepatische enzephalopathie
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