Hepatic encephalopathy (HE) is a prognostically relevant neuropsychiatric syndrome that occurs in the course of acute or chronic liver disease. Besides ascites and variceal bleeding, it is the most serious complication of decompensated liver cirrhosis. Ammonia and inflammation are major triggers for the appearance of HE, which in patients with liver cirrhosis involves pathophysiologically low-grade cerebral oedema with oxidative/nitrosative stress, inflammation and disturbances of oscillatory networks in the brain. Severity classification and diagnostic approaches regarding mild forms of HE are still a matter of debate. Current medical treatment predominantly involves lactulose and rifaximin following rigorous treatment of so-called known HE precipitating factors. New treatments based on an improved pathophysiological understanding are emerging. 

https://digital.csic.es/bitstream/10261/306057/1/Acceso_restringido.pdf

Hepatic encephalopathy.

AASLD Practice Guidance: Palliative care and symptom‐based management in decompensated cirrhosis

Rifaximin ist ein Breitbandantibiotikum, welches nahezu vollständig (>99%) im Darm verbleibt, sodass systemische Nebenwirkungen und/oder Resistenzentwicklungen auch bei Langzeitbehandlung sehr gering sind. Verschiedene Studien konnten für Rifaximin in der Behandlung der hepatischen Enzephalopathie (HE) bei Leberzirrhose eine signifikante Wirksamkeit bei geringem Nebenwirkungsprofil nachweisen (Zeneroli et al. Chemotherapy 2005; 51 [Suppl 1]: 90–95). Neben der Behandlung der akut auftretenden HE ist zusätzlich die remissionserhaltende Therapie wichtig. Als Standardpräparate gelten seit Langem nicht resorbierbare Disaccharide wie Lactulose (Sharma et al. Gastroenterology 2009; 137: 885–891).

Rifaximin treatment in hepatic encephalopathy

Sleep and liver disease: a bidirectional relationship.

Sleep disturbances often result from inappropriate lifestyles, incorrect dietary habits, and/or digestive diseases. This clinical condition, however, has not been sufficiently explored in this area. Several studies have linked the circadian timing system to the physiology of metabolism control mechanisms, energy balance regulation, and nutrition. Sleep disturbances supposedly trigger digestive disorders or conversely represent specific clinical manifestation of gastrointestinal (GI) diseases. Poor sleep may worsen the symptoms of GI disorders, affecting the quality of life. Conversely, short sleep may influence dietary choices, as well as meal timing, and the circadian system drives temporal changes in metabolic patterns. Emerging evidence suggests that patients with inappropriate dietary habits and chronic digestive disorders often sleep less and show lower sleep efficiency, compared with healthy individuals. Sleep disturbances may thus represent a primary symptom of digestive diseases. Further controlled trials are needed to fully understand the relationship between sleep disturbances, dietary habits, and GI disorders. It may be also anticipated that the evaluation of sleep quality may prove useful to drive positive interventions and improve the quality of life in a proportion of patients. This review summarizes data linking sleep disorders with diet and a series of disease including gastro-esophageal reflux disease, peptic disease, functional gastrointestinal disorders, inflammatory bowel diseases, gut microbiota alterations, liver and pancreatic diseases, and obesity. The evidence supporting the complex interplay between sleep dysfunction, nutrition, and digestive diseases is discussed.

/pdf/sleep-disorders-related-to-nutrition-and-digestive-diseases-50da1vvbtb.pdf

Sleep disorders related to nutrition and digestive diseases: a neglected clinical condition.

Background and aimSleep disorders are frequently reported in patients with cirrhosis and hepatic encephalopathy (HE). This study assessed the effect of rifaximin on sleep architecture parameters in patients with recurrent HE.Patients and methodsThis sequential, prospective, and exploratory study inv

Improvement of sleep architecture parameters in cirrhotic patients with recurrent hepatic encephalopathy with the use of rifaximin.

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Improvement of sleep architecture parameters in cirrhotic patients with recurrent hepatic encephalopathy with the use of rifaximin.