Dietary management of hepatic encephalopathyBMJ 1999; 318 doi: https://doi.org/10.1136/bmj.318.7195.1364 (Published 22 May 1999) Cite this as: BMJ 1999;318:1364
Too many myths persist
- Carol A Seymour, Professor of clinical biochemistry and metabolic medicine,
- Kevin Whelan, Gastroenterological dietitian
- St George's Hospital Medical School, London SW17 0RE
Papers (p 1391)
Myths are difficult to dispel and may delay good evidence based clinical practice. This is illustrated well by a paper in this week's issue on the dietary management of hepatic encephalopathy in patients with cirrhosis (p 1391).1 Protein restriction in symptomatic patients with hepatic encephalopathy has been the cornerstone of treatment since the 1950s,2 yet there is no evidence that it has any clinical benefit.
Hepatic encephalopathy is a syndrome of impaired mental status and abnormal neuromuscular function which results from major failure of liver function. Important factors contributing to it are the degree of hepatocellular failure, portosystemic shunting, and exogenous factors such as sepsis and variceal bleeding.3 The pathogenesis of the syndrome is still uncertain, although current hypotheses include impaired hepatic detoxification of ammonia absorbed from the gut4 and an …