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HERDIN Record #: PCHRD031809060337 Submitted: 19 March 2009

L-ornithine aspartate among cirrhotic patients with hepatic encephalopathy: Does it make a difference?.

Randy S. Mercado,
Lieza  T. Pilar

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Background: Hepatic Encephalopathy is a complication of liver failure. Over the last two decades, studies have shown the beneficial use of "ammonia lowering" drugs, particularly amino acids, such ornithine-aspartate among patients with hepatic encephalopathy.

Objectives: To determine the effectivity of L-ornithine aspartate among patients with cirrhosis complicated with hepatic encephalopathy. Search strategy: An electronic search using Medline, Pubmed, Medscape, Science Direct and Cochrane Library Documents, Search terms included L-ornithine aspartate searched with liver cirrhosis and/or hepatic encephalopathy.

Selection criteria: Randomized controlled trials comparing the effect of L-ornithine asparate and placebo for at least seven days among patients diagnosed with cirrhosis and hepatic encephalopathy. Decisions regarding inclusion of data were duplicated while disagreements were resolved by discussion or a third party.

Data collection and analysis: Three reviewers assessed trial quality and compared outcomes independently. Weighted Mean Difference (WMD) and relative risk ratios were computed using Revman Manager 4.2.8. Heterogeneity was determined using forest plots, chi2 and F tests.

Main results: Three RCTs met the criteria and were included in the study (n = 277). Treatment with L-ornithine aspartate showed that there was a significant improvement to patient's mental state after therapy as compared to placebo with a fixed OR 0.42 (CI 95 percent 0.23, 0.78). However, there was no significant change in the mean PSE Index between therapy and placebo (WMD 0.09 CI 95% 0.05, 0.13). On the other hand, no summary statistics can be derived from the pooled data with regards to change in the mean ammonia level because of the significant heterogeneity in the included trials.

Reviewers' conclusions: Although the evidence from the three RCTs suggests that L-ornithine aspartate is effective in improving the mental state gradient, more high quality trials are required to conclusively determine the benefit of L-ornithine aspartate among cirrhotic patients.

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Philippine Journal of Gastroenterology
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General Objective: To determine the effectiveness of L-ornithine aspartate on cirrhotic patients complicated with hepatic encephalopathy.

Specific Objectives:

1. To be able to determine the effect on the improvement of mental state gradient with the use of L-ornitine aspartate.
2. To determine the effect on the change in mean ammonia blood level with the use of L-omithine aspartate.
3. To determine the effect on the change in mean PSE Index with the use of L-ornithine aspartate.

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