Advertisement

Digestive Diseases and Sciences

, Volume 36, Issue 9, pp 1204–1208 | Cite as

Short-term oral zinc supplementation does not improve chronic hepatic encephalopathy

Results of a double-blind crossover trial
  • Oliviero Riggio
  • Franco Ariosto
  • Manuela Merli
  • Massimo Caschera
  • Angelo Zullo
  • Genoveffa Balducci
  • Vincenzo Ziparo
  • Giovanni Pedretti
  • Franco Fiaccadori
  • Emilio Bottari
  • Livio Capocaccia
Original Articles

Abstract

The effect of short-term oral zinc supplementation (zinc sulfate 600 mg/day) on hepatic encephalopathy, was assessed in a double-blind, crossover trial. Fifteen cirrhotic patients with stable, chronic hepatic encephalopathy were randomized to receive either oral zinc or a placebo for 10 days. Following a two-week washout period, these were crossed over to the alternate treatment. Conn's index, which comprises the evaluation of the mental state, asterixis, number connection test, EEG record, and plasma ammonia, was used to score the degree of hepatic encephalopathy, both at the beginning and end of each treatment period. Serum zinc was significantly raised after oral zinc administration and reached the levels observed in cirrhotics without hepatic encephalopathy. Despite this, however, no modification in the parameters included in Conn's index were observed. In conclusion, this study failed to confirm that short-term oral zinc supplementation improves chronic hepatic encephalopathy.

Key Words

zinc hepatic encephalopathy controlled trial 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Vallee BL, Wacker WEC, Bartholomay AF, Robin ED: Zinc metabolism in hepatic dysfunction. N Engl J Med 225:403–408, 1956Google Scholar
  2. 2.
    Scholmerich J, Lohla E, Gerok W: Zinc and vitamin A deficiency in liver cirrhosis. Hepato-Gastroenterol 30:119–125, 1983Google Scholar
  3. 3.
    Valberg LS, Flanagan PR, Ghent CN: Zinc absorption and leukocyte zinc in alcoholic and nonalcoholic cirrhosis. Dig Dis Sci 30:329–333, 1985Google Scholar
  4. 4.
    Scholmerich J, Becher MS, Kottgen E, Rauch N, Haussinger D, Lohle E, Vuilleumier JP, Gerok W: The influence of portosystemic shunting on zinc and vitamin A metabolism in liver cirrhosis. Hepato-Gastroenterol 30:143–147, 1983Google Scholar
  5. 5.
    Rabbani P, Prasad AS: Plasma ammonia and liver ornithine transcarbamylase activity in zinc-deficient rats. Am J Physiol 235:E203-E206, 1978Google Scholar
  6. 6.
    Cassidy WA, Broen ED, Smith CJ: Alterations in zinc and vitamin A metabolism in alcoholic liver disease: A review.In Zinc and Copper in Clinical Medicine. KM Hambridge, BL Nichols (eds). New York, SP Medical and Scientific Books, 1978, pp 59–79Google Scholar
  7. 7.
    Riggio O, Merli M, Ariosto F, Pieche U, Capocaccia L: Zinc supplementation reduces blood ammonia and increases liver ornithine transcarbamylase (OCT) activity in experimental cirrhosis. Hepatology 12:858, 1990 (abstract)Google Scholar
  8. 8.
    Baraldi M, Caselgrandi E, Borella P, Zeneroli L: Decrease of brain zinc in experimental hepatic encephalopathy. Brain Res 258:170–172, 1982Google Scholar
  9. 9.
    Walwork JC, Botnen JH, Sanstead LL: Influence of dietary zinc on rat brain catecolamines. J Nutr 112:514–519, 1982Google Scholar
  10. 10.
    Reding P, Duchateau J, Bataille C: Oral zinc supplementation improves hepatic encephalopathy. Lancet 1:493–495, 1984Google Scholar
  11. 11.
    Maier KP: Progress in the treatment of portal-systemic encephalopathy (PSE). J Hepatol 5:355–361, 1987Google Scholar
  12. 12.
    Uribe M: Dietary management of portal systemic encephalopathy.In Hepatic Encephalopathy: Management with Lactulose and Related Carbohydrates. HO Conn, J Bircher (eds). Michigan, Medi-Ed Press, 1988, ppGoogle Scholar
  13. 13.
    Conn HO, Leevy CM, Vlavechic ZR, Rodgers DB, Maddrey NC, Seeff L, Levy LL: A comparison of lactulose and neomycin in the treatment of portal-systemic encephalopathy: A double blind controlled trial. Gastroenterol 72:573–583, 1977Google Scholar
  14. 14.
    Morgan MY, Hewley KE, Stambuk D: Lactitol versus lactulose in the treatment of chronic hepatic encephalopathy. A double-blind, randomised, cross-over study. J Hepatol 4:236–244, 1987Google Scholar
  15. 15.
    Uribe M, Toledo H, Perez F, Vargas F, Gil S, Garcia-Ramos G, et al: Lactitol, a second-generation disaccharide for treatment of chronic portal-systemic encephalopathy. Dig Dis Sci 32:1345–1353, 1987Google Scholar
  16. 16.
    Swart GR, Van den Berg JWO, Wattimena JLD, Rietveld T, Van Vuure JK, Frenkel M: Elevated protein requirements in cirrhosis of the liver investigated by whole body protein turnover studies. Clin Sci 75:101–107, 1988Google Scholar
  17. 17.
    Swart GR, Van den Berg JWO, Van Vuure JK, Rietveld T, Wattimena DL, Frenkel M: Minimum protein requirements in liver cirrhosis determined by nitrogen balance measurements at three levels of protein intake. Clin Nutr 8:329–336, 1989Google Scholar
  18. 18.
    Karayalcin S, Arcasoy A, Uzunalimoglu O: Zinc plasma levels after oral inc tolerance test in nonalcoholic cirrhosis. Dig Dis Sci 33:1096–1102, 1988Google Scholar
  19. 19.
    Boyett JD, Sullivan JF: Distribution of protein-bound zinc in normal and cirrhotic serum. Metabolism 19:148–151, 1970Google Scholar
  20. 20.
    Solomon MV, Cousins RJ: Zinc.In Absorption and Malabsorption of Mineral Nutrients. NW Solomon, IH Rosemberg (eds). New York, Alan R Liss, 1984, pp 122–138Google Scholar
  21. 21.
    Scholmerich J, Freudemann A, Kottgen E, Wietholtz H, Steiert B, Lohle E, Haussinger D, Gerok W: Bioavailability of zinc from zinc-histidine complexes. I Comparison with zinc sulfate in healthy men. Am J Clin Nutr 45:1486–1489, 1987Google Scholar
  22. 22.
    Scholmerich J, Krauss E, Wietholtz H, Kottgen E, Lohle E, Gerok W: Bioavailability of zinc from zinc-histidine complexes. II Studies on patients with liver cirrhosis and the influence of the time application. Am J Clin Nutr 45:1487–1491, 1987Google Scholar

Copyright information

© Plenum Publishing Corporation 1991

Authors and Affiliations

  • Oliviero Riggio
    • 1
  • Franco Ariosto
    • 1
  • Manuela Merli
    • 1
  • Massimo Caschera
    • 1
  • Angelo Zullo
    • 1
  • Genoveffa Balducci
    • 1
  • Vincenzo Ziparo
    • 1
  • Giovanni Pedretti
    • 1
  • Franco Fiaccadori
    • 1
  • Emilio Bottari
    • 1
  • Livio Capocaccia
    • 1
  1. 1.the II Cattedra di Gastroenterologia, I Clinica Chirurgica, Dipartimento di Chimica, Università di Roma “La Sapienza;” Cattedra di Malattie InfettiveUniversità di ParmaRomeItaly

Personalised recommendations