Effect of L-ornithine-L-aspartate on patients with and without TIPS undergoing glutamine challenge: a double blind, placebo controlled trial

Background and aim-An oral glutamine load in cirrhotic patients awaiting li ver transplantation was shown to cause a rise in blood ammonia and psychome tric abnormalities which were reversed by hepatic transplantation. L-Omithi ne-L-aspartate (LOLA) has been shown to reduce ammonia and improve psychome tric function in patients with hepatic encephalopathy. The aim of the prese nt study was to assess the effect of LOLA in healthy patients with cirrhosi s and no evidence of clinical encephalopathy after challenging the central nervous system by administration of oral glutamine. Patients and methods-Eight cirrhotics (Child's B or C) without transjugular intrahepatic portosystemic shunts (TIPS) and seven with TIPS underwent two oral glutamine (20 g) challenges, receiving LOLA (5 g intravenously) on on e occasion and placebo on the other in random order. Psychometric tests, in cluding choice reaction time (CRT) and number connection test, were perform ed before and after glutamine, together with electroencephalography and blo od ammonia. Results-Mean basal ammonia was 27 (SEM. 5) mu mol/l in non-TIPS and 76 (10) mu mol/l in TIPS patients (p<0.05). Basal CRT 2 was 0.643 (0.033) s in non -TIPS and 0.825 (0.076) s in TIPS patients (p<0.02). In non-TIPS patients, ammonia increased to 36 (10) mu mol/l when LOLA was administered and to 62 (13) mu mol/l with placebo (p<0.02). There was no alteration in psychometri c function in non-TIPS patients after glutamine when LOLA was given but whe n placebo was given, glutamine caused prolongation of CRT (p=0.02). Glutami ne did not affect psychometric function in TIPS patients with or without LO LA. LOLA ameliorated Conclusion-This LOLA ameliorated the deleterious psychometric effects of gl utamine in Child's grade a and C patients with cirrhosis without TIPS and s upports its use in clinical practice in hepatic encephalopathy.