Cirrhosis of the Liver Community
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Any suggestions on how to deal with Cirroshis

Does anyone dealing with someone with Cirroshis go through such mood swings and repeating and going on and on about same subject?
It's maddening I can't take this much more.
It's a shame what has happened to my husband but he has caused it unfortunately.
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683231 tn?1467326617
Has he been evaluated for hepatic encephalopathy? Please discuss with his doctor the symptoms you are seeing. There are medicines he can take to help with his symptoms if HE is the cause.

From Web MD:

“What Is Hepatic Encephalopathy?

You've had liver disease for a while, but now you notice something different about the way you act and feel. Maybe you forget things or get confused when someone's talking to you. Your friends may tell you that your speech sounds slurred or that you say things that aren't appropriate.

And it isn’t only changes in behavior. You might feel sluggish or find that you can't move your hands well anymore. Or your breath doesn't smell like it should.

What's going on? Is there a link to the liver problems you've been dealing with for years?

It could be. You may have hepatic encephalopathy (HE), a disorder caused by a buildup of toxins in the brain that can happen with advanced liver disease. It affects a lot of things, like your behavior, mood, speech, sleep, or the way you move.

Sometimes the symptoms are so mild that it's hard for anyone to notice. But whether you have obvious signs or just a few subtle changes, it's important to see your doctor. The right treatment can help keep your condition under control, but if you don't take care of yourself, your condition will continue to worsen.


Your liver has several big jobs to do. One key task is to clean your blood by getting rid of harmful chemicals that your body makes.

Hepatic encephalopathy starts when your liver gets damaged from a disease you've had a long time, like chronic hepatitis, Reye's syndrome, or cirrhosis. It doesn't work right anymore, and toxins get into your bloodstream and travel to your brain. They build up there and cause the mental and physical symptoms of HE.

Several things can trigger an episode or make your condition worse. For example, you could be at risk for problems if you have a tube called a shunt placed in your liver. You might have this done to help reroute your blood flow to treat cirrhosis or another long-term disease. There's a chance that this procedure will allow toxins to bypass your liver and move to your brain.

Other things can set off hepatic encephalopathy, too. It might happen because you:

Have an infection
Get constipated
Don't get enough to drink
Bleed from your intestines, stomach, or esophagus
Take certain medicines like some sleeping pills, pain relievers, or water pills
Have kidney problems
Go on an alcohol binge.


There's a lot of variety in the way HE affects people. Not everyone has the same symptoms. For some folks, they may be very slight or come and go.

In some cases, the effects of hepatic encephalopathy start slowly and then get worse bit by bit. But sometimes they hit you hard all at once.

There are some mental signs to watch out for. For instance, you may:
Get confused
Forget things
Feel nervous or excited
Notice a sudden change in your personality or behavior
Speak or act inappropriately to others
Not feel interested in things
Get cranky
Of course, when it comes to changes in behavior, sometimes you're the last one to realize that something is off. So if you've got a long-term liver disease, ask your family and friends to be on the lookout for shifts in your personality. Tell them to be honest with you if they see your mood has changed or you're just not acting like your old self.

You may also notice some changes in your sleep patterns. You could feel sleepy during the day or stay up late at night.

Some physical changes can start creeping in, too. You may notice that:

Your breath smells sweet or musty.
It's hard to move or use your hands.
When you hold out your arms or hands, they shake or flap.
Your speech sounds slurred.
You feel slow or sluggish when you move your body.


You've got a number of choices. A lot depends on your specific situation. For instance, your doctor will take into account things like:

What triggers your episodes
How severe a case you have
The types of symptoms you get
How serious your long-term liver disease is
How old you are and your overall health

Your doctor may suggest two types of drugs that reduce the toxins in your body:

Lactulose. This is a type of sugar that can make you have more bowel movements. This helps get rid of some toxins from your body, like ammonia, which can trigger HE.

Antibiotics. Drugs like neomycin (Neo-Fradin) and rifaximin (Rifagut, Xifaxan) may help. They curb bacteria that create toxins when they digest your food.

Your doctor may also ask you to take some other steps that can improve your symptoms:

Change your diet. If you eat a lot of meat, your body may make too much ammonia. Your doctor may ask you to cut back, but you still need to get enough protein from other sources. Try dairy and veggies. Also eat frequent small meals rather than three big ones a day.

Skip alcohol. Even a little bit can be risky for you because it damages your liver.

Treat infections. They can affect the way your liver works. You may need antibiotics to get rid of them.

Treat urinary blockages. If you can't pee normally, it can trigger your HE. Treatment for the infection or disease that's causing it can help.

Stop some medications. Certain medicines, such as sedatives or narcotics, may cause problems with your liver.

Treat constipation. You may need to eat less meat and more vegetables. This can help you have more regular bowel movements so you can flush toxins from your body.

What to Expect

HE can be divided into stages according to how severe your symptoms are. If you're in an early stage, the right treatment can ease your symptoms.

HE is graded based on signs and symptoms:

Grade 1: Mild. You may have slurred speech, trouble sleeping or find it hard to concentrate.

Grade 2: Moderate. You may feel like you don't have much energy. Some personality changes and confusion may become more obvious, like acting odd or forgetting things.

Grade 3: Severe. You may be extremely confused and not be able to speak coherently. You could also get extremely sleepy or pass out, though you'll wake up when someone tries to rouse you.

Grade 4: Coma. In this phase, you may pass out and and not respond to pain or someone trying to wake you.

These grades may sound scary, but remember, HE can be treated if you act promptly. Work with your doctor closely and follow his instructions carefully.”
Avatar universal
Fecal Transplant improves Encephalopathy Symptoms and reduces Hospitalizations

Fecal microbiota transplants improve cognitive impairment caused by severe liver disease
Fecal microbiome transfer significantly reduced the number of hospitalizations compared to standard of care treatment

    April 21, 2017
    European Association for the Study of the Liver
    Fecal transplantation of bacteria from one healthy donor into patients that suffer from hepatic encephalopathy, is safe and improves cognitive function compared with standard of care treatment for the condition, new research concludes. The study results also demonstrated that the number of hospitalizations following fecal transplantation plus antibiotics was two, compared to the standard of care arm, which was 11.
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A study presented found that fecal transplantation of bacteria from one healthy donor into patients that suffer from hepatic encephalopathy (decline in brain function due to severe liver disease), is safe and improves cognitive function compared with standard of care treatment for the condition. Presented at The International Liver Congress™ 2017 in Amsterdam, The Netherlands, the study results also demonstrated that the number of hospitalisations following fecal transplantation plus antibiotics was two, compared to the standard of care arm (lactulose and rifaximin), which was 11 (IQR 83 days). Specifically, there was a significant reduction in hospitalisations due to recurrent hepatic encephalopathy (six in the standard of care and none in the fecal transplant arm).

In the study, fecal transplant plus antibiotic treatment was well tolerated without any serious side effects. Furthermore, it was found that the fecal transplant plus antibiotic therapy restored antibiotic-associated changes in the body's bacterial composition.

"Hepatic encephalopathy is a serious condition and a leading cause of re-admission to hospital due to recurrence, despite standard of care treatment," said Dr Jasmohan Bajaj, Virginia Commonwealth University, Richmond, United States of America, and lead author of the study. "The results from this study demonstrate that in patients with hepatic encephalopathy, a fecal transplant improves brain function more than standard of care as well as reducing the number of hospital admissions, including those for recurrent hepatic encephalopathy. fecal transplantation is an innovative and promising approach to treat this condition, and we look forward to more studies being conducted to confirm our results."

Researchers randomised 20 men with cirrhosis who experienced recurrent episodes of hepatic encephalopathy prior to the start of the study, to treatment with lactulose and rifaximin (standard of care treatment), or, broad spectrum antibiotics for five days plus a single fecal transplant from a healthy donor along with continuing the standard of care. The transplant was given as an enema. Patients were followed for up to 150 days after randomisation.

There was significant cognitive improvement in the fecal transplant group on the Psychometric Hepatic Encephalopathy Score (PHES) and the Stroop App (another test of cognitive dysfunction) as compared to the standard of care group. The Model for End Stage Liver Disease (MELD) score significantly increased following treatment with antibiotics (delta 1.7, p<0.001) but returned to baseline following the fecal transplant (delta -0.2, p=0.5, day 20). fecal transplant also increased beneficial strains of bacteria, including Bifidobacteriaceae and Lactobacillaceae. In the standard of care arm, there were no significant microbiota, metabolomics, cognitive or MELD changes seen.

Overall, one patient in the fecal transplant group had decreased cognitive function, however he had higher baseline Proteobacteria, (a group of bacteria that includes a wide variety of pathogens, such as Escherichia, Salmonella, Vibrio, and Helicobacter), which did not respond to the fecal transplant.

Hepatic encephalopathy occurs when the liver cannot remove certain toxins and chemicals, such as ammonia, from the blood.1 These toxins and chemicals then build up and enter the brain.1 Hepatic encephalopathy is one of the major complications of cirrhosis (scarring of the liver), and a leading cause of hospital re-admission due to its recurrence, despite treatment.1 It can occur suddenly in people with acute liver failure, but is seen more often in those with chronic liver disease.1 Symptoms of hepatic encephalopathy include mild confusion, forgetfulness, poor concentration and personality or mood changes, but can progress to extreme anxiety, seizures, severe confusion, jumbled and slurred speech and slow movement.1 The first step in treatment is to identify and treat any factors that cause hepatic encephalopathy.2 Once the episode has resolved, further treatment aims to reduce the production and absorption of toxins, such as ammonia.1 Generally, there are two types of medication used to reduce the likelihood of another hepatic encephalopathy episode -- lactulose and rifaximin.2 However, it remains a leading cause of hospitalisations and re-hospitalisations in cirrhotic patients, despite the use of the above-mentioned standard of care treatment.

"This is the first randomised trial to show that fecal transplantation may be of benefit to patients with hepatic encephalopathy. The encouraging findings open new avenues of research to determine how to best manipulate the gut microbiota in patients with hepatic encephalopathy. They also show proof-of-concept for the likely beneficial impact of such interventions, adding to what is already known for non-absorbable antibiotics like rifaximin," said Prof Tom Karlsen, Department of Transplantation Medicine, Oslo University Hospital Rikshospitalet, Norway and EASL Vice-Secretary.

Story Source: https://www.sciencedaily.com/releases/2017/04/170421084925.htm
Hi mikesimon

Sounds like really interesting and promising research.

Do you know if this treatment is currently available for patients or would the OP have to find a clinical trial for her husband?
Hi there Flyinlynn,

I do not know whether this procedure has been approved in this setting. I have followed fecal transplantation for several years in the setting of C. Difficile. Although it was effective with C. Diff doctors were reluctant to suggest it to patients thinking they would be unlikely to choose to undergo the procedure. When patients were polled it showed that the chronic long term sufferers were quite willing to have the procedure. What I am getting at here is that I would think one would have to be pretty aggressive and/or have a very enlightened physician in order to pursue this approach. The procedure has become less objectionable and I believe that the stool can be reduced to a capsule which takes a lot of the unpleasantness out of it. If I were suffering from severe encephalopathy I would definitely look into it.
Thanks for the info sounds like it may be able to help a lot of patients.
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