RESUMO
Pharmacologic management of hepatic encephalopathy includes a broad range of therapies. This article covers the specific mainstays of therapies, such as antimicrobials and laxatives, with an established evidence base. This article also covers newer modalities of therapies, such as fecal microbiota transplant, probiotics, bioartificial support systems, small molecular therapies such as l-ornithine l-aspartate, branched chain amino acids, l-carnitine, zinc, and other forms of therapy currently under review.
Assuntos
Antibacterianos/uso terapêutico , Encefalopatia Hepática/terapia , Laxantes/uso terapêutico , Rifaximina/uso terapêutico , Acarbose/uso terapêutico , Aminoácidos de Cadeia Ramificada/uso terapêutico , Dipeptídeos/uso terapêutico , Transplante de Microbiota Fecal , Flumazenil/uso terapêutico , Moduladores GABAérgicos/uso terapêutico , Glicerol/análogos & derivados , Glicerol/uso terapêutico , Inibidores de Glicosídeo Hidrolases/uso terapêutico , Humanos , Lactulose/uso terapêutico , Fenilbutiratos/uso terapêutico , Probióticos/uso terapêuticoAssuntos
Antivirais/uso terapêutico , Procedimentos Clínicos , Gastroenterologia , Hepatite C Crônica/tratamento farmacológico , Sociedades Médicas , Algoritmos , Antivirais/efeitos adversos , Técnicas de Apoio para a Decisão , Prestação Integrada de Cuidados de Saúde , Hepatite C Crônica/diagnóstico , Humanos , Equipe de Assistência ao Paciente , Valor Preditivo dos Testes , Resposta Viral Sustentada , Resultado do Tratamento , Estados UnidosRESUMO
Weight loss, regular exercise, and diet composition modification seem to improve biochemical and histologic abnormalities. Other therapies directed at insulin resistance, oxidative stress, cytoprotection, and fibrosis may also offer benefits. Insulin sensitizers and vitamin E seem to be the most promising; however, they cause side effects. A multifaceted approach of lifestyle modifications, weight loss, and pharmacotherapy can be used in combination, but no single treatment approach has proved universally applicable to the general population with nonalcoholic steatohepatitis (NASH). Continuous clinical and preclinical studies on existing and potential drugs are needed to improve treatment of nonalcoholic fatty liver disease/NASH.