• Hepatic encephalopathy-free survival [ Time Frame: 56 weeks ] [ Designated as safety issue: No ]
  

• Overall duration in days of episodic hepatic encephalopathy [ Time Frame: 56 weeks ] [ Designated as safety issue: No ]
  
• Minimal hepatic encephalopathy assessed by neuropsychological tests [ Time Frame: 56 weeks ] [ Designated as safety issue: No ]
  
• Health-related quality of life [ Time Frame: 56 weeks ] [ Designated as safety issue: No ]
  
• Nutritional status [ Time Frame: 56 weeks ] [ Designated as safety issue: No ]
  
• Liver function [ Time Frame: 56 weeks ] [ Designated as safety issue: No ]
  

Hepatic encephalopathy is a major complication of cirrhosis associated with poor prognosis and poor quality of life. Appearance of HE occurs in the setting of precipitating factors that increase plasma ammonia. The gastrointestinal tract is the primary source of ammonia, which is produced by enterocytes from glutamine and by colonic bacterial catabolism of nitrogenous sources, such as ingested proteins. This is the rationale for proposing low-protein diet as strategy to reduce ammonia production and as standard diet in patients with cirrhosis and hepatic encephalopathy. However, low-protein diet could cause wasting muscle and predispose to recurrence of hepatic encephalopathy, since muscle is an important site for extrahepatic ammonia removal.

Branched-chain amino acids have shown beneficial effects on mental state of patients with chronic hepatic encephalopathy. The possible mechanism of action may be improvement of nutritional status through induction of protein synthesis. However, role of branched-chain amino acids in treatment and prevention of acute hepatic encephalopathy is not established. Administration of a normal-protein diet containing oral branched-chain amino acids may reduce recurrence of hepatic encephalopathy as compared to a low-protein diet.