Efficacy of L-Ornithine-L-Aspartate in Cirrhotics With Hepatic Encephalopathy
Efficacy of L-Ornithine-L-Aspartate in Cirrhotics With Hepatic Encephalopathy
The purpose of this study is to determine whether L-Ornithine L-Aspartate is effective for
 the improvement of Overt Hepatic Encephalopathy.
There is no effective treatment available for hepatic encephalopathy at the moment; therefore
 we aimed to check the efficacy and safety of L-ornithine L-aspartate(LOLA). It provides
 critical substrates for ureagenesis and glutamine synthesis, the two primary mechanisms by
 which the body rids itself of excess ammonia. Ornithine is a specific activator of ornithine
 carbamyl transferase and carbamylphosphate synthetase, and, in addition, is a substrate for
 ureagenesis. These reactions are carried out mainly in the periportal portion of the hepatic
 lobules. Aspartate and ornithine, after conversion to alfa-ketoglutarate, are substrates for
 glutamine synthesis, which is performed exclusively by a small population of perivenous
 hepatocytes, the so-called perivenous scavenger cells. The ammonia lowering effect resulting
 from the stimulation of these two basic mechanisms of ammonia detoxification has been studied
 in animals and was confirmed in humans in clinical trials.
Inclusion Criteria:

 -  Cirrhosis, diagnosed on the basis of clinical findings, sonographic, and/or histologic
 basis,

 -  Patients >14 years, with HE grades 1 to 4 according to West Haven Criteria,

 -  Hyperammonemia (fasting venous blood ammonia level >60 µmol/l), and

 -  Patients with a single reversible precipitating factor of HE such as constipation,
 hypokalemia, urinary tract infection, respiratory tract infection, spontaneous
 bacterial peritonitis (SBP), dehydration, or none.

 Exclusion Criteria:

 -  hepatocellular carcinoma,

 -  severe septicemia,

 -  active gastrointestinal bleeding,

 -  hepatorenal syndrome,

 -  acute superimposed liver injury,

 -  advanced cardiac or pulmonary disease and end stage renal failure,

 -  patients with minimal HE

 -  patients taking sedatives, antidepressants, or benzodiazepines and

 -  patients with chronic HE on metronidazole or lactulose prior to admission.