GuidelineAlimentary pharmacology & therapeutics2011
Review article: the design of clinical trials in hepatic encephalopathy--an International Society for Hepatic Encephalopathy and Nitrogen Metabolism (ISHEN) consensus statement.
Guideline in Alimentary pharmacology & therapeutics, 2011. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 2 registered trials, which are not on this map. Cited by 153 papers, 13 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Efficacy of Intravenous 'L-ornithine L-aspartate' in Reversal of Overt Acute Hepatic Encephalopathy in Patients With Liver Cirrhosis: a Prospective, Randomized, Double-blind, Placebo Controlled Trial
A Phase III, 52-week, Multinational, Multicenter, Randomized, Double-blind, 2-arm Parallel Group Study Comparing Efficacy, Safety and Tolerability of the Fixed Dose Triple Combination of Beclomethasone Dipropionate Plus Formoterol Fumarate Plus Glycopyrronium Bromide (CHF 5993) With the Fixed Dose Dual Combination of Beclomethasone Dipropionate Plus Formoterol Fumarate (CHF 1535), Both Administered Via pMDI in Subjects With Chronic Obstructive Pulmonary Disease (COPD)
Who cites it
153 citing papers in PubMed, 13 syntheses or guidelines pooled it, 345 citations in OpenAlex.
- Aminoglycosides, vancomycin, and metronidazole for people with cirrhosis and hepatic encephalopathy.The Cochrane database of systematic reviews · 2026Pooled it
- Branched-chain amino acids for people with cirrhosis and hepatic encephalopathy.The Cochrane database of systematic reviews · 2026Pooled it
- Rifaximin for prevention and treatment of hepatic encephalopathy in people with cirrhosis.The Cochrane database of systematic reviews · 2023Pooled it
- KASL clinical practice guidelines for liver cirrhosis: Varices, hepatic encephalopathy, and related complications.Clinical and molecular hepatology · 2020Guideline
- Chinese guidelines on management of hepatic encephalopathy in cirrhosis.World journal of gastroenterology · 2019Guideline
- Pharmacotherapies that specifically target ammonia for the prevention and treatment of hepatic encephalopathy in adults with cirrhosis.The Cochrane database of systematic reviews · 2019Pooled it
- L-ornithine L-aspartate for prevention and treatment of hepatic encephalopathy in people with cirrhosis.The Cochrane database of systematic reviews · 2018Pooled it
- Flumazenil versus placebo or no intervention for people with cirrhosis and hepatic encephalopathy.The Cochrane database of systematic reviews · 2017Pooled it
- Flumazenil versus placebo or no intervention for people with cirrhosis and hepatic encephalopathy.The Cochrane database of systematic reviews · 2017Pooled it
- Branched-chain amino acids for people with hepatic encephalopathy.The Cochrane database of systematic reviews · 2017Pooled it
- Probiotics for people with hepatic encephalopathy.The Cochrane database of systematic reviews · 2017Pooled it
- Non-absorbable disaccharides versus placebo/no intervention and lactulose versus lactitol for the prevention and treatment of hepatic encephalopathy in people with cirrhosis.The Cochrane database of systematic reviews · 2016Pooled it
- Dopamine agents for hepatic encephalopathy.The Cochrane database of systematic reviews · 2014Pooled it
- Rifaximin Improves Cognitive Performance and Reduces Cirrhosis-Related Adverse Events in Covert Hepatic Encephalopathy: A Randomized Controlled Trial.Alimentary pharmacology & therapeutics · 2026Trial
- The Cirrhosis Medical Home: A Pilot Randomized Trial of a Collaborative Care Model for Patients With Decompensated Cirrhosis.Clinical and translational gastroenterology · 2026Trial
- Efficacy and Safety of Pregabalin for Muscle Cramps in Liver Cirrhosis: A Double-Blind Randomized Controlled Trial.Journal of Korean medical science · 2022Trial
- GR3027 reversal of neurosteroid-induced, GABA-A receptor-mediated inhibition of human brain function: an allopregnanolone challenge study.Psychopharmacology · 2018Trial
- Prolonged remission from hepatic encephalopathy with rifaximin: results of a placebo crossover analysis.Alimentary pharmacology & therapeutics · 2015Trial
- Randomized, double-blind, controlled study of glycerol phenylbutyrate in hepatic encephalopathy.Hepatology (Baltimore, Md.) · 2014Trial
- Mini-Mental State Examination in patients with hepatic encephalopathy and liver cirrhosis: a prospective, quantified electroencephalography study.BMC gastroenterology · 2013Trial
93 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
8 authors at 6 institutions in 5 countries.
Funding
Abstract
backgroundThe clinical classification of hepatic encephalopathy is largely subjective, which has led to difficulties in designing trials in this field.
aimsTo review the current classification of hepatic encephalopathy and to develop consensus guidelines on the design and conduct of future clinical trials.
methodsA round table was convened at the 14th International Society for Hepatic Encephalopathy and Nitrogen Metabolism (ISHEN) meeting. Key discussion points were the nomenclature of hepatic encephalopathy and the selection of patients, standards of care and end-points for assessing the treatment and secondary prevention of hepatic encephalopathy.
resultsIt was generally agreed that severity assessment of hepatic encephalopathy in patients with cirrhosis, whether made clinically or more objectively, should be continuous rather than categorical, and a system for assessing the SONIC (Spectrum of Neuro-cognitive Impairment in Cirrhosis) was proposed. Within this system, patients currently classified as having minimal hepatic encephalopathy and Grade I hepatic encephalopathy would be classified as having Covert hepatic encephalopathy, whereas those with apparent clinical abnormalities would continue to be classified as overt hepatic encephalopathy. Some aspects of the terminology require further debate. Consensus was also reached on the patient populations, standards of care and endpoints to assess clinical trial outcomes. However, some compromises had to be made as there is considerable inter- and intravariability in the availability of some of the more objective surrogate performance markers.
conclusionsThe objectives of the round table were met. Robust, defendable guidelines for the conduct of future studies into hepatic encephalopathy have been provided. Outstanding issues are few and will continue to be discussed.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.