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Abstract(s)
A encefalopatia hepática é uma síndrome neuropsiquiátrica associada à
falência hepática aguda ou crónica, que tem apresentações clínicas muito
variáveis, mas que afecta de uma forma limitativa e grave o dia-a-dia dos
doentes, a sua vida relacional e a família globalmente. A sua patogénese é multifactorial e não completamente esclarecida, mas a amónia desempenhará
um papel fulcral na sua etiopatogenia. Ao longo dos anos têm sido testadas várias opções terapêuticas, mas
com resultados pouco animadores. A lactulose pela sua acção catárctica e alterações bioquímicas do lúmen intestinal, continua a ser o agente mais
usado, embora nem sempre com os resultados esperados. Os antibióticos
orais, ao actuar sobre a flora bacteriana intestinal produtora de amónia, foram
sendo usados na encefalopatia, mas devido aos efeitos secundários foram progressivamente abandonados. Mas o surgimento da rifaximina, um derivado
semi-sintético da rifamicina, com características ideais em termos de actuação
ao nível do intestino, foi testado em várias situações com resultados muito promissores. As propriedades singulares deste antibiótico, associadas a efeitos
secundários mínimos, foram usadas com êxito no tratamento da encefalopatia
hepática.
Nos Estados Unidos, a rifaximina está disponível desde 2004, mas a aprovação da sua indicação na encefalopatia hepática ocorreu recentemente,
em Março de 2010, após múltiplos estudos controlados, e com resultados que
justificaram essa introdução no mercado americano. Em Portugal dispomos da rifaximina desde Outubro de 2009, tendo sido aprovada a comparticipação para o tratamento da diarreia infecciosa aguda
não-invasiva. Perante a pertinência e actualidade destes dados, e tratando-se de uma patologia com resultados pouco satisfatórios com as múltiplas terapêuticas tradicionalmente em uso, pretendeu-se rever os estudos que avaliaram as múltiplas opções no tratamento da encefalopatia hepática, confrontar com a rifaximina, actualmente já disponível em Portugal, e alertar para a existência desta nova arma terapêutica ao dispor da comunidade médica portuguesa.
Hepatic encephalopathy is a neuropsychiatric syndrome associated with acute or chronic liver failure highly restricts, in a very family and relational life globally. fully understood, but that increased blood levels of role. Over the years several therapeutic options have been tested overall results have not been very encouraging cathartic action and biochemical alterations of the intestinal most widely used agent, although antibiotics, acting on the being used in encephalopathy abandoned. But the rifamycin, with ideal characteristics in terms various situations with very promising results. The unique properties of this antibiotic, combined with minimal side effects, have been used successfully in the treatment of hepatic encephalopathy In the United States since 2004, the approval encephalopathy occurred whose findings justified its entry into the U.S. mark Rifaximina no Tratamento da Encefalopatia Hepática Junho de 2010 III ABSTRACT Hepatic encephalopathy is a neuropsychiatric syndrome associated with failure, which has highly variable clinical presentations very limited and serious way, the daily lives of patients, their family and relational life globally. Its pathogenesis is multifactorial and not yet that increased blood levels of ammonia plays an important Over the years several therapeutic options have been tested overall results have not been very encouraging. Lactulose cathartic action and biochemical alterations of the intestinal lumen most widely used agent, although not always with the expected results. Oral ting on the ammonia-producing intestinal bacterial flora, were being used in encephalopathy, but due to side effects were progressively ut the emergence of rifaximin, a semi-syntheti rifamycin, with ideal characteristics in terms of action in the gut, was tested in situations with very promising results. The unique properties of this combined with minimal side effects, have been used successfully in the treatment of hepatic encephalopathy. In the United States, although rifaximin has been available on the market approval for its use in the clinical setting encephalopathy occurred only in March 2010 after multiple controlle justified its entry into the U.S. market. [...]
Hepatic encephalopathy is a neuropsychiatric syndrome associated with acute or chronic liver failure highly restricts, in a very family and relational life globally. fully understood, but that increased blood levels of role. Over the years several therapeutic options have been tested overall results have not been very encouraging cathartic action and biochemical alterations of the intestinal most widely used agent, although antibiotics, acting on the being used in encephalopathy abandoned. But the rifamycin, with ideal characteristics in terms various situations with very promising results. The unique properties of this antibiotic, combined with minimal side effects, have been used successfully in the treatment of hepatic encephalopathy In the United States since 2004, the approval encephalopathy occurred whose findings justified its entry into the U.S. mark Rifaximina no Tratamento da Encefalopatia Hepática Junho de 2010 III ABSTRACT Hepatic encephalopathy is a neuropsychiatric syndrome associated with failure, which has highly variable clinical presentations very limited and serious way, the daily lives of patients, their family and relational life globally. Its pathogenesis is multifactorial and not yet that increased blood levels of ammonia plays an important Over the years several therapeutic options have been tested overall results have not been very encouraging. Lactulose cathartic action and biochemical alterations of the intestinal lumen most widely used agent, although not always with the expected results. Oral ting on the ammonia-producing intestinal bacterial flora, were being used in encephalopathy, but due to side effects were progressively ut the emergence of rifaximin, a semi-syntheti rifamycin, with ideal characteristics in terms of action in the gut, was tested in situations with very promising results. The unique properties of this combined with minimal side effects, have been used successfully in the treatment of hepatic encephalopathy. In the United States, although rifaximin has been available on the market approval for its use in the clinical setting encephalopathy occurred only in March 2010 after multiple controlle justified its entry into the U.S. market. [...]
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Keywords
Encefalopatia hepática Encefalopatia hepática - Diagnóstico Encefalopatia hepática - Tratamento Encefalopatia hepática - Rifaximina Encefalopatia hepática - Terapias emergentes Encefalopatia hepática - Antibióticos orais Falência hepática
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Universidade da Beira Interior