Nutritional status in hepatic encephalopathy and transjugular intrahepatic portosystemic shunt - TIPS, and strategies to improve the outcomes

• Published in: Acta gastro-enterologica belgica Vol. 86; no. 2; p. 318
• Main Author: Berenguer, M
• Format: Journal Article
• Language: English
• Published: Belgium 01.04.2023
• Subjects: Esophageal and Gastric Varices - complications; Esophageal and Gastric Varices - surgery; Gastrointestinal Hemorrhage - etiology; Hepatic Encephalopathy - epidemiology; Hepatic Encephalopathy - etiology; Humans; Liver Cirrhosis - complications; Liver Cirrhosis - surgery; Nutritional Status; Portasystemic Shunt, Transjugular Intrahepatic - adverse effects; Retrospective Studies; Sarcopenia - etiology; Treatment Outcome; frailty; nutrition; transjugular intrahepatic portosystemic shunt; encephalopathy; cirrhosis; sarcopenia
• ISSN: 1784-3227
• DOI: 10.51821/86.2.11430

Hepatic encephalopathy (HE) is one of the most severe complications following transjugular intrahepatic portosystemic shunt (TIPS). The identification and treatment of risk factors associated with the development of this complication may reduce the incidence and severity of post-TIPS HE. Several studies have demonstrated that the nutritional status plays a major role in the outcome of the cirrhotic population, particularly those who are decompensated. Although scarce, there are also studies highlighting an association between poor nutritional status, sarcopenia, fragile status, and post-TIPS HE. If these data are confirmed, nutritional support could become a means for decreasing this complication, thereby enhancing the use of TIPs in the treatment of refractory ascites or variceal bleeding. In this review, we will discuss the pathogenesis of HE, the data that supports an association with sarcopenia, nutritional status and frailty and the implications that these conditions have on the use of TIPS in clinical practice.