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Treatment of minimal hepatic encephalopathy

Several reports, conducted as a placebo‐controlled, double‐blind study, presented a favorable result in treating MHE. They included branched chain aminoacid, fluzazenil‐a benzodiazepin receptor antagonist, lactulose, lactitol, and L‐ornithin‐L‐aspartate. Lactulose and lactitol have been shown to be effective in MHE. It improved psychomotor tests and lowered ammonia levels as well as quality of life. Branched chain amino acids (BCAAs) were reported to improve nitrogen metabolism, blood ammonia level, and psychomotor tests. Flumazenil, an antagonist of benzodiazepine receptor, has not been associated with established consensus on the effectiveness in MHE. L‐ornithine‐L‐aspartate (OA) exerts its ammonia‐lowering action in the kidney, skeletal muscles, brain, as well as in the liver. OA administered per orally improved number connection test, ammonia levels, and mental state. OA may be a promising therapy for patients with MHE. A shunt‐closure manipulation with balloon occluded retrograde transvenous obliteration (BRTO) has been shown to be effective for hepatic encephalopathy and its efficacy in MHE has not been elucidated. Synbiotic modulation of gut flora. was shown to increase fecal content of non‐urease‐producing Lactobacillus species and this change was associated with a reversal of MHE. In conclusion, there are no definitive conclusion on the treatment of MHE because of difficulties in diagnosis and evaluation. Therapeutic strategy should be planned specifically for each patient depending on the etiological factors.