Original articlesA randomized controlled trial of acarbose in hepatic encephalopathy
Section snippets
Patients and methods
All patients gave their written informed consent to enter the study, which was conducted according to the Declaration of Helsinki and after approval by the local Ethical Committee.
Results
After randomization, 55 patients were initially treated with acarbose, and 52 patients were initially treated with placebo. No dropouts were observed during the study, and all the patients had stable liver function, evaluated according to Child–Pugh score.27 No adverse events or complications caused by cirrhosis or side effects caused by treatments occurred during the study.
Discussion
Acarbose is a novel hypoglycemic agent that acts by inhibiting gastrointestinal α-glucosidase activities, the enzymatic system responsible for glucose absorption in the gastrointestinal tract. We studied whether acarbose exerted any effect on ammonia blood levels, HE, and postprandial hyperglycemia in cirrhotic patients with grade 1–2 HE and type 2 diabetes. Acarbose was significantly superior to placebo in decreasing ammonia blood levels, causing a 52.6% ± 9.4% decrease compared with baseline
References (43)
- et al.
Successful longterm treatment of portal-systemic encephalopathy by the benzodiazepine antagonist flumazenil
Gastroenterology
(1989) - et al.
Incidence of altered glucose tolerance in liver cirrhosis
Diabetes Res Clin Pract
(1993) - et al.
Alteration of glucose metabolism in chronic liver disease
Diabetes Res Clin Pract
(1990) - et al.
Effects of spontaneous portal-systemic shunting on insulin metabolism
Gastroenterology
(1979) - et al.
Interindividual variability of the number connection test
J Hepatol
(1992) - et al.
Acarbose-induced acute severe hepatotoxicity (
Lancet
(1997) Pathogenesis and treatment of portal-systemic encephalopathyan update
Dig Dis Sci
(1992)Pathophysiology of hepatic encephalopathy
Hepatogastroenterology
(1991)- et al.
Blood and brain concentrations of mercaptans in hepatic and metanethiol induced coma
Gut
(1984) Theoretic therapy of hepatic encephalopathy
Protein load induced ureogenesis and ammoniogenesis in patients with non-alcoholic liver cirrhosis
Increased intestinal hydrolysis of urea in patients with alcoholic cirrhosis
Scand J Gastroenterol
Treatment of hepatic encephalopathy with non-absorbable antibiotics
Ital J Gastroenterol
Lactobacillus acidophilus (empac) in the treatment of hepatic encephalopathy
Br Med J
Der Diabetes mellitus
Study on the carbohydrate metabolism in chronic infectious hepatitis
Arch Intern
Liver diseases and diabetes mellitus
Glucose tolerance and diabetes mellitus in chronic liver disease
Lancet
Liver disease and diabetes mellitus
Diabetes Rev
Glibenclamide associated reversible cholestasis
Eur J Med
Effect of treatment with acarbose and insulin in patients with non-insulin-dependent diabetes mellitus associated with non-alcoholic liver cirrhosis
Diabetes Obes Metab
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2022, Journal of Clinical and Experimental HepatologyCitation Excerpt :Another advantage of AGI is that they may have a beneficial effect in hepatic encephalopathy by decreasing proteolytic flora (which increase NH3 levels) & increasing saccharolytic flora besides having a laxative effect, which may contribute to the improvement of hepatic encephalopathy. In a study of acarbose in patients with low-grade hepatic encephalopathy and diabetes mellitus, besides improvement in glycemic control, treatment with acarbose resulted in a decrease in blood ammonia levels and hepatic encephalopathy.116 While there are rare reports of acarbose-induced hepatotoxicity,117–119 AGI has low systemic absorption and hepatic metabolism and are considered to be safe in patients with cirrhosis.120
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Supported by a grant from the Italian Ministry of University and Scientific and Technological Research and, in part, by a special grant from the Italian Association for Diabetes (AID-Stabia, Castellammare di Stabia, Naples, Italy).