Flumazenil vs. placebo in hepatic encephalopathy in patients with cirrhosis: a meta‐analysis

@article{Goulenok2002FlumazenilVP,
  title={Flumazenil vs. placebo in hepatic encephalopathy in patients with cirrhosis: a meta‐analysis},
  author={Cyril Goulenok and Brigitte Bernard and Jean François Cadranel and D. Thabut and Vincent Di Martino and Pierre Opolon and T. Poynard},
  journal={Alimentary Pharmacology \& Therapeutics},
  year={2002},
  volume={16}
}
Randomized controlled trials testing flumazenil in hepatic encephalopathy have shown conflicting results. 
Current and emerging strategies for treating hepatic encephalopathy.
Effects of l-Acetylcarnitine on Cirrhotic Patients with Hepatic Coma: Randomized Double-Blind, Placebo-Controlled Trial
TLDR
It is demonstrated that LAC administration improved neurological and biohumoral symptoms in selective cirrhotic patients with hepatic coma and no side effects were observed in the study series.
Flumazenil versus placebo or no intervention for people with cirrhosis and hepatic encephalopathy.
TLDR
This review found no beneficial or harmful effects of flumazenil on all-cause mortality, but found a beneficial effect on hepatic encephalopathy, based on an analysis of eight randomised clinical trials.
Pharmacotherapy for Hepatic encephalopathy: view of Evidence-Based
TLDR
Rifaximin appears at least to be as effective as conventional treatments, but not superior to them, and L-Ornithine-L-aspartate appears to be a safe and effective treatment of chronic HE when compared with a placebo regime.
Evidence-based approach to management of hepatic encephalopathy in adults
TLDR
This review aims to provide an update on the conventional and emerging treatment options for He and identify and treating the precipitating factors.
Management of hepatic encephalopathy
TLDR
Evidence for proven therapeutical efficacy in HE on the basis of placebo‐controlled trials is existing only for transplantation, protein restriction, administration of vegetable proteins, ornithine‐aspartate, oral branched‐chain amino acid treatment as well as lactulose enemas.
Treating hepatic encephalopathy in cirrhotic patients admitted to ICU with sodium phenylbutyrate: a preliminary study
TLDR
In cirrhotic patients with overt HE, sodium PB could be effective in reducing ammonia levels and might be effectiveIn improving neurological status and ICU discharge survival, more extensive data are mandatory.
Management of portal hypertension.
  • H. Nietsch
  • Medicine
    Journal of clinical gastroenterology
  • 2005
TLDR
Rational medical and endoscopic therapy is guided by a thorough understanding of the underlying pathophysiology of ascites, variceal formation and bleeding, hepatorenal syndrome, and hepatic encephalopathy.
Hepatic encephalopathy.
Emerging drugs for hepatic encephalopathy
TLDR
Competence in testing old and new treatment modalities by RCTs with appropriate clinically relevant end points should urgently be improved.
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TLDR
The infusion of 0.4-1 mg flumazenil results in a modest but rapid improvement in the EEG grading of hepatic encephalopathy and to a moderate but delayed improved in the clinical grade of hepato-cephalopathy.
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The results of this study suggest that flumazenil is beneficial only in a selected subset of cirrhotic patients with severe HE; the applicability of this treatment to unselected patients with hepatic coma or to cirrhosis patients with less severe HE still remains to be determined.
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This study does not support a major therapeutic effect of flumazenil on hepatic encephalopathy, and a trend for clinical improvement only in the patients with chronic liver disease, but without significant changes in the mean dominant frequency.
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BZA seems to improve hepatic encephalopathy, especially at an early stage (II), and it appears less effective in stage III, most of all when there is evidence of brain oedema.
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Flumazenil is beneficial only in a selected subset of cirrhotic patients with severe HE; the applicability of this treatment to unselected patients withsevere HE still remains to be determined.
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