Pathogenesis of Hepatic Encephalopathy

Overview

Journal Gastroenterol Res Pract

Publisher Wiley

Specialty Gastroenterology

Date 2013 Jan 15

PMID 23316223

Citations 21

Authors

Irena Ciecko-Michalska

Malgorzata Szczepanek

Agnieszka Slowik

Tomasz Mach

Affiliations

Soon will be listed here.

Abstract

Hepatic encephalopathy can be a serious complication of acute liver failure and chronic liver diseases, predominantly liver cirrhosis. Hyperammonemia plays the most important role in the pathogenesis of hepatic encephalopathy. The brain-blood barrier disturbances, changes in neurotransmission, neuroinflammation, oxidative stress, GABA-ergic or benzodiazepine pathway abnormalities, manganese neurotoxicity, brain energetic disturbances, and brain blood flow abnormalities are considered to be involved in the development of hepatic encephalopathy. The influence of small intestine bacterial overgrowth (SIBO) on the induction of minimal hepatic encephalopathy is recently emphasized. The aim of this paper is to present the current views on the pathogenesis of hepatic encephalopathy.

Citing Articles

Dodder ( sp.) extract prevents cognitive deficits in a rat model of hepatic encephalopathy.

Albayrak O, Hatipoglu B, Ozbeyli D, Sen A, Koyuncuoglu T, Cevik O North Clin Istanb. 2024; 11(6):512-519.

PMID: 39650325 PMC: 11622753. DOI: 10.14744/nci.2023.95776.

The Management of Postoperative Cognitive Dysfunction in Cirrhotic Patients: An Overview of the Literature.

Ingustu D, Pavel B, Paltineanu S, Mihai D, Cotorogea-Simion M, Martac C Medicina (Kaunas). 2023; 59(3).

PMID: 36984466 PMC: 10053389. DOI: 10.3390/medicina59030465.

Protocol for a case-control prospective study to investigate the impact of patic ncephalopathy on utritional Intake and arcopenia status in patients with end-stage er disease: HENS-LIV study.

Towey J, Ngonadi C, Rajoriya N, Holt A, Greig C, Armstrong M BMJ Open Gastroenterol. 2022; 9(1).

PMID: 36564096 PMC: 9791380. DOI: 10.1136/bmjgast-2022-001052.

Ameliorative effect of oregano (Origanum vulgare) versus silymarin in experimentally induced hepatic encephalopathy.

Abdelghffar E, El-Nashar H, Fayez S, Obaid W, Eldahshan O Sci Rep. 2022; 12(1):17854.

PMID: 36284120 PMC: 9596437. DOI: 10.1038/s41598-022-20412-3.

Hepatic Encephalopathy and Melatonin.

Arjunan A, Sah D, Do Jung Y, Song J Antioxidants (Basel). 2022; 11(5).

PMID: 35624703 PMC: 9137547. DOI: 10.3390/antiox11050837.

References

Abbott N . Dynamics of CNS barriers: evolution, differentiation, and modulation. Cell Mol Neurobiol. 2005; 25(1):5-23. PMC: 11529509. DOI: 10.1007/s10571-004-1374-y. View

Srivastava A, Yadav S, Yachha S, Thomas M, Saraswat V, Gupta R . Pro-inflammatory cytokines are raised in extrahepatic portal venous obstruction, with minimal hepatic encephalopathy. J Gastroenterol Hepatol. 2011; 26(6):979-86. DOI: 10.1111/j.1440-1746.2011.06706.x. View

Mardini H, Smith F, Record C, Blamire A . Magnetic resonance quantification of water and metabolites in the brain of cirrhotics following induced hyperammonaemia. J Hepatol. 2010; 54(6):1154-60. DOI: 10.1016/j.jhep.2010.09.030. View

Gitlin N . Subclinical portal-systemic encephalopathy. Am J Gastroenterol. 1988; 83(1):8-11. View

Tarter R, Hegedus A, Van Thiel D, Schade R, Gavaler J, Starzl T . Nonalcoholic cirrhosis associated with neuropsychological dysfunction in the absence of overt evidence of hepatic encephalopathy. Gastroenterology. 1984; 86(6):1421-7. PMC: 2963938. View

Gupta A, Dhiman R, Kumari S, Rana S, Agarwal R, Duseja A . Role of small intestinal bacterial overgrowth and delayed gastrointestinal transit time in cirrhotic patients with minimal hepatic encephalopathy. J Hepatol. 2010; 53(5):849-55. DOI: 10.1016/j.jhep.2010.05.017. View

Weissenborn K, Ennen J, Schomerus H, Ruckert N, Hecker H . Neuropsychological characterization of hepatic encephalopathy. J Hepatol. 2001; 34(5):768-73. DOI: 10.1016/s0168-8278(01)00026-5. View

Groeneweg M, Quero J, de Bruijn I, Hartmann I, Essink-Bot M, Hop W . Subclinical hepatic encephalopathy impairs daily functioning. Hepatology. 1998; 28(1):45-9. DOI: 10.1002/hep.510280108. View

Rao K, Norenberg M . Cerebral energy metabolism in hepatic encephalopathy and hyperammonemia. Metab Brain Dis. 2001; 16(1-2):67-78. DOI: 10.1023/a:1011666612822. View

10.

Wolburg H, Lippoldt A . Tight junctions of the blood-brain barrier: development, composition and regulation. Vascul Pharmacol. 2003; 38(6):323-37. DOI: 10.1016/s1537-1891(02)00200-8. View

11.

Norenberg M, Jayakumar A, Rama Rao K, Panickar K . New concepts in the mechanism of ammonia-induced astrocyte swelling. Metab Brain Dis. 2007; 22(3-4):219-34. DOI: 10.1007/s11011-007-9062-5. View

12.

Abbott N, Patabendige A, Dolman D, Yusof S, Begley D . Structure and function of the blood-brain barrier. Neurobiol Dis. 2009; 37(1):13-25. DOI: 10.1016/j.nbd.2009.07.030. View

13.

Goulenok C, Bernard B, Cadranel J, Thabut D, Di Martino V, Opolon P . Flumazenil vs. placebo in hepatic encephalopathy in patients with cirrhosis: a meta-analysis. Aliment Pharmacol Ther. 2002; 16(3):361-72. DOI: 10.1046/j.1365-2036.2002.01191.x. View

14.

Abbott N . Astrocyte-endothelial interactions and blood-brain barrier permeability. J Anat. 2002; 200(6):629-38. PMC: 1570746. DOI: 10.1046/j.1469-7580.2002.00064.x. View

15.

Butterworth R . Altered glial-neuronal crosstalk: cornerstone in the pathogenesis of hepatic encephalopathy. Neurochem Int. 2010; 57(4):383-8. DOI: 10.1016/j.neuint.2010.03.012. View

16.

Rama Rao K, Jayakumar A, Norenberg D . Ammonia neurotoxicity: role of the mitochondrial permeability transition. Metab Brain Dis. 2003; 18(2):113-27. DOI: 10.1023/a:1023858902184. View

17.

Clemmesen J, Larsen F, Kondrup J, Hansen B, Ott P . Cerebral herniation in patients with acute liver failure is correlated with arterial ammonia concentration. Hepatology. 1999; 29(3):648-53. DOI: 10.1002/hep.510290309. View

18.

Blei A, Olafsson S, Therrien G, Butterworth R . Ammonia-induced brain edema and intracranial hypertension in rats after portacaval anastomosis. Hepatology. 1994; 19(6):1437-44. View

19.

Abbott N, Romero I . Transporting therapeutics across the blood-brain barrier. Mol Med Today. 1996; 2(3):106-13. DOI: 10.1016/1357-4310(96)88720-x. View

20.

Kulisevsky J, Pujol J, Junque C, Deus J, Balanzo J, Capdevila A . MRI pallidal hyperintensity and brain atrophy in cirrhotic patients: two different MRI patterns of clinical deterioration?. Neurology. 1993; 43(12):2570-3. DOI: 10.1212/wnl.43.12.2570. View