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Role of diabetes mellitus on hepatic encephalopathy

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Abstract

Hepatic encephalopathy is the main cognitive dysfunction in cirrhotic patients associated with impaired prognosis. Hyperammonemia plus inflammatory response do play a crucial role on hepatic encephalopathy. However, in some patients HE appeared without hyperammonemia and patients with increased levels of ammonia could not show cognitive dysfunction. This has led to investigate other factors that could act in a synergistic way. Diabetes mellitus and insulin resistance are characterized by releasing and enhancing these pro-inflammatory cytokines and, additionally, has been related to hepatic encephalopathy. Indeed, patients with diabetes showed raised risk of over hepatic encephalopathy in comparison with non-cirrhotics. Type 2 diabetes mellitus could impair hepatic encephalopathy by different mechanisms that include: a) increasing glutaminase activity; b) impairing gut motility and promoting constipation, intestinal bacterial overgrowth and bacterial translocation. Despite of insufficient clarity about the practicability of anti-diabetic therapy and the most efficacious therapy, we would have to pay a special attention to the management of type 2 diabetes mellitus and insulin resistance in cirrhotic patients.

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Abbreviations

HE:

Hepatic encephalopathy

DM:

Diabetes mellitus

T2DM:

Type 2 diabetes mellitus

HD:

Hepatogenous diabetes

TNFα:

Tumor necrosis factor alpha

IL-6:

Interleukin 6

GLS:

Glutaminase

KGLS:

Kidney-type glutaminase

LGLS:

Liver-type glutaminase

BBB:

Blood brain barrier

IR:

Insulin resistance

SIBO:

Small intestine bacterial overgrowth

MHE:

Minimal hepatic encephalopathy

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Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Unit for Clinical Management of Digestive Diseases and CIBERehd, Hospital Universitario de Valme, University of Sevilla, Avenida de Bellavista s/n, Sevilla, 41014, Spain

    Javier Ampuero, Isidora Ranchal, José Antonio del Campo & Manuel Romero-Gómez

  2. Department of Molecular Biology, University of Sevilla, Sevilla, Spain

    María del Mar Díaz-Herrero & Juan D. Bautista

Authors
  1. Javier Ampuero
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  2. Isidora Ranchal
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  3. María del Mar Díaz-Herrero
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  4. José Antonio del Campo
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  5. Juan D. Bautista
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  6. Manuel Romero-Gómez
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Corresponding author

Correspondence to Manuel Romero-Gómez.

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Ampuero, J., Ranchal, I., del Mar Díaz-Herrero, M. et al. Role of diabetes mellitus on hepatic encephalopathy. Metab Brain Dis 28, 277–279 (2013). https://doi.org/10.1007/s11011-012-9354-2

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  • DOI: https://doi.org/10.1007/s11011-012-9354-2

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