Management of hepatic encephalopathy with oral zinc supplementation: a long-term treatment

Abstract

Objectives: The effect of long-term oral zinc supplementation, in addition to standard therapy (protein-restricted diet and lactulose) on recurrent hepatic encephalopathy, was assessed in a double-blind study.

Methods: Ninety cirrhotic patients with stable recurrent hepatic encephalopathy, after following a one month period of standard therapy, were randomized to receive oral zinc acetate supplementation (600 mg/day) in addition to standard therapy or to continue only standard therapy (a diet containing 0.8 g/kg/day of protein and 90 g/day of lactulose) for six months. Psychometric tests, NCT (number correction test) and PSE (portal-systemic encephalopathy) Index, were used to evaluate the degree of hepatic encephalopathy, both at the beginning and the end of each treatment period.

Results: Oral zinc supplementation in addition to standard therapy was able to normalize serum zinc levels. The patients who never showed clinical signs of hepatic encephalopathy during the trial were 88.6% in zinc-group and 86% in only standard therapy group. Psychometric tests, NCT and PSE Index, were statistically better than basal values either in zinc-group or in only standard therapy group.

Conclusions: Final values of psychometric tests were better in zinc-group than only standard therapy group but the differences were not statistically significant.