title: Management of hepatic encephalopathy with oral zinc supplementation: a long-term treatment. Hepatic encephalopathy: A neurochemical, neuroanatomical, and neuropsychological study ORAL ZINC SUPPLEMENTATION IMPROVES HEPATIC ENCEPHALOPATHY: Results of a Randomised Controlled Trial Subclinical hepatic encephalopathy: proton MR spectroscopic abnormalities.
abstract: OBJECTIVES The effect of long-term oral zinc supplementation , in addition to st and ard 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 st and ard therapy , were r and omized to receive oral zinc acetate supplementation ( 600 mg/day ) in addition to st and ard therapy or to continue only st and ard 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 st and ard 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 st and ard therapy group . Psychometric tests , NCT and PSE Index , were statistically better than basal values either in zinc-group or in only st and ard therapy group . CONCLUSIONS Final values of psychometric tests were better in zinc-group than only st and ard therapy group but the differences were not statistically significant Hepatic encephalopathy ( HE ) is normally diagnosed by neuropsychological ( NP ) tests , which are not very specific and do not reveal the underlying pathology . Magnetic resonance imaging ( MRI ) and spectroscopy ( MRS ) of the brain offer alternative and possibly more specific markers for HE . These methods were applied in conjunction with NP testing in order to determine their usefulness in the identification of HE and to underst and the pathogenesis of HE more clearly . MR imaging and spectroscopy examinations , in addition to a battery of 15 NP tests , were administered to investigate 31 patients awaiting liver transplantation and 23 healthy controls . MR image intensities from the globus pallidus region were calculated and normalized to those of the thalamus . Absolute concentrations and ratios with respect to creatine ( Cr ) of several metabolites were computed from MR spectra . The MR data were correlated with the results of NP tests . The patients showed impairment in NP tests of attention and visuospatial and verbal fluency . In T1 weighted MRI , the relative intensity of the globus pallidus with respect to that of the thalamus region was significantly elevated in patients and correlated ( negatively ) with three NP tests ( Hooper , FAS , and Trails B ) . The absolute concentrations of myo‐inositol ( mI ) and choline ( Ch ) were significantly reduced in three brain regions . In addition , the absolute concentrations of glutamine ( Gln ) and combined glutamate and glutamine ( Glx ) were increased in all three locations , with Gln increase being significant in all areas while that of Glx only in the occipital white matter . In summary , this study partially confirms a hypothesized mechanism of HE pathogenesis , an increased synthesis of glutamine by brain glutamate in astrocytes due to excessive blood ammonia , followed by a compensatory loss of myo‐inositol to maintain astrocyte volume homeostasis . It also indicates that the hyperintensity observed in globus pallidus could be used as complementary to the NP test scores in evaluating the mental health of HE patients . PACS number : 22 cirrhotic patients with chronic encephalopathy were given oral zinc supplementation or placebo in a double-blind r and omised trial . In the group which received zinc acetate 600 mg a day for 7 days , serum zinc had been restored to normal by day 8 . On day 8 hepatic encephalopathy , as assessed by a trailmaking test , was improved in the supplemented group but not in the placebo group . There was also a significant increase in blood urea nitrogen in the supplemented group . Short-term oral zinc supplementation probably improved hepatic encephalopathy by correcting the zinc deficiency that compromises conversion of ammonia to urea . The duration of this improvement requires further investigation PURPOSE To determine whether hydrogen-1 magnetic resonance ( MR ) spectroscopy of the brain allows detection of sub clinical hepatic encephalopathy ( SCHE ) .  MATERIAL S AND METHODS In a double-blind study , overt hepatic encephalopathy ( HE ) and SCHE ( defined with clinical and neuropsychiatric tests ) were compared by means of H-1 MR spectroscopic criteria --reduction in cerebral myo-inositol ( < 2 st and ard deviations [ SDs ] from normal ) and choline ( < 2 SDs from normal ) with or without increased cerebral glutamine ( > 1 SD from normal)--in 20 patients with cirrhosis . RESULTS Concordance between MR spectroscopic and neuropsychiatric test results was 94 % ( kappa = 0.84 ) . MR spectroscopy allowed diagnosis of SCHE in nine of nine patients ( 100 % ) and of HE in seven of eight ( 88 % ) . Myo-inositol depletion alone had 80%-85 % sensitivity for detection of HE and SCHE . CONCLUSION H-1 MR spectroscopy allows accurate diagnosis of SCHE , and the results suggest an important role for myo-inositol in psychomotor and visuopractic functions
target: Conclusion Oral zinc supplementation improved performance on the number connection test , but no evidence about other clinical or biochemical outcomes was available
background: Background and aim Because low serum zinc levels precipitate hepatic encephalopathy , zinc supplementation is considered a potential therapeutic option .
  The aim of this study was to assess the effects of oral zinc supplementation in the treatment of hepatic encephalopathy .