Antioxidants and Zinc Improving Minimal Hepatic Encephalopathy In Truck Drivers; a Pilot Study
Antioxidants and Zinc Improving Minimal Hepatic Encephalopathy In Truck Drivers; a Pilot Study
Minimal hepatic encephalopathy (MHE) can have a far-reaching impact on quality and ability to
 function in daily life and may progress to overt Hepatic Encephalopathy. Patients with MHE
 were missed in clinical follow up and are more exposure to work accident. The aim of the
 present study was to assess the effects of oral supplementation of antioxidant and zinc
 gluconate Versus Lactulose inTruck driver cirrhotic patients with MHE.
The aim of the present study was to assess the effects of oral supplementation of antioxidant
 and zinc gluconate in patients with MHE. Zinc, may be considered as a cofactor of urea cycle
 enzymes, that deficient in cirrhotic patients; especially if associated, with malnutrition or
 encephalopathy . Zinc is essential for the synthesis of coenzymes that mediate biogenic amine
 synthesis and metabolism. Data from studies sustain that, there is a synergistic combined
 effect between systemic oxidative stress, and ammonia that is implicated in the pathogenesis
 of hepatic encephalopathy, so that the present study was designed to assess the effects of
 oral supplementation of antioxidant and zinc gluconate in cirrhotic Truck drivers patients
 with MHE.

 A prospective randomized controlled study comparing the effect of zinc and antioxidant
 supplementation plus lactulose on MHE versus lactulose alone. Patients who were diagnosed as
 having MHE were randomly assigned either to receive zinc and antioxidant plus lactulose
 (group A) or lactulose alone (group B, the control). Patients in group A received 175 mg zinc
 gluconate, 50000 iu vitamin A, 500 mg vitamin C and 100 mg vitamin E once daily plus
 lactulose (30-60 ml in 2 or 3 divided doses), while patients in group B received 30-60 ml
 lactulose in 2 or 3 divided doses so that the patient passed 2-3 semi soft stools per day.
 The therapy was taken daily for 3 months or until the patients discontinued the study drugs
 for any reason (e.g. non compliance). All patients were followed up every month for treatment
 compliance and for development of any complications. The compliance with the therapy was
 assured primarily by ensuring increased stool frequency and a change to a softer consistency
 and by counting the number of bottles of lactulose consumed. None of the study, patients were
 specifically treated by other therapy for MHE within the study period (e.g. rifaximin).
Inclusion Criteria:

 -  Truck drivers with liver cirrhosis and minimal hepatic encephalopathy.

 Exclusion criteria:

 -  Overt hepatic encephalopathy.

 -  Sensory or motor deficits; neurological causes of impaired cognition

 -  Electrolyte imbalances (serum sodium level <125 mmol/L; serum calcium level >10 mg per
 /DL and potassium level <2.5 mmol/L)

 -  Ongoing systemic illnesses, intercurrent infection or active spontaneous bacterial
 peritonitis.

 -  Recent history (< 6 weeks) of alcohol intake.

 -  Patients on drugs affecting psychometric performances.

 -  Recent (<6 weeks) intake of antibiotics for gastrointestinal bleeding, history of
 shunt operation or trans jugular intrahepatic portosystemic shunt for portal
 hypertension.

 -  Chronic renal impairment (creatinine level >2.0 mg per/ DL.

 -  Patients with color blindness, mature cataract and diabetic retinopathy,

 -  Hepatocellular carcinoma, or other comorbidities such as congestive heart failure and
 pulmonary disease.