Management of hepatic encephalopathy with oral zinc supplementation: a long-term treatment

The effect of long-term oral zinc supplementation, in addition to standard therapy (protein-restricted diet and lactulose) on recurrent hepatic encephalopathy, was assessed in a double-blind study.

Ninety cirrhotic patients with stable recurrent hepatic encephalopathy, after following a one month period of standard therapy, were randomized to receive oral zinc acetate supplementation (600 mg/day) in addition to standard therapy or to continue only standard therapy (a diet containing 0.8 g/kg/day of protein and 90 g/day of lactulose) for six months. Psychometric tests, NCT (number correction test) and PSE (portal-systemic encephalopathy) Index, were used to evaluate the degree of hepatic encephalopathy, both at the beginning and the end of each treatment period.

Oral zinc supplementation in addition to standard therapy was able to normalize serum zinc levels. The patients who never showed clinical signs of hepatic encephalopathy during the trial were 88.6% in zinc-group and 86% in only standard therapy group. Psychometric tests, NCT and PSE Index, were statistically better than basal values either in zinc-group or in only standard therapy group.

Final values of psychometric tests were better in zinc-group than only standard therapy group but the differences were not statistically significant.