Diet Management on Hepatic Encephalopathy of Patients With Variceal Bleeding After Intrahepatic Portosystemic Shunt Creation
Diet Management on Hepatic Encephalopathy of Patients With Variceal Bleeding After Intrahepatic Portosystemic Shunt Creation
Hepatic encephalopathy is a severe complication of transjugular intrahepatic portosystemic
 shunt (TIPS) treatment in patients with cirrhosis and variceal bleeding. This study is
 specially designed to explore whether diet management strategy could decrease incidence of
 encephalopathy after TIPS treatment.
Hepatic encephalopathy (HE) is a severe complication of TIPS treatment in patients with
 cirrhosis and variceal bleeding. The overall incidence of post-TIPS encephalopathy ranges
 between 10% and 50%, and even the percentage of the new or worsened HE was evaluated up to
 13-36%. No approach or medication was evidenced for prophylaxis of post-TIPS encephalopathy,
 including lactulose and rifaximin. Diet management has been used as an important part of the
 prophylaxis and treatment strategy for patients with metabolic diseases like diabetes and
 nephritis, which has drawn increasing interest of clinicians. Nevertheless, there is still no
 standard consensus or even recommendation for patients after TIPS procedure for now, which
 worsened malnutrition and affected survival. Thus, this study is specially designed to
 explore whether diet management strategy, drawn up from the nutritional management consensus
 of hepatic encephalopathy (ISHEN consensus), could decrease incidence of encephalopathy after
 TIPS treatment of the patient with cirrhosis and variceal bleeding.
Inclusion Criteria:

 -  patients with decompensated liver cirrhosis regardless of the etiology

 -  acute variceal bleeding or with history of variceal bleeding evidenced by endoscopy

 -  an age between 18 and 75 years old

 Exclusion Criteria:

 -  a total bilirubin level more than 3mg/dL (51.3mmol/L)

 -  a creatinine level greater than 3 mg/dL(265umol/L)

 -  severe dysfunction of heart and respiratory system

 -  pregnancy

 -  uncontrolled neoplasm

 -  active systemic infection

 -  history of any kind of encephalopathy, mental disease, alcohol dependence, or any
 other status that influence brain function

 -  diabetes or any other metabolic diseases