Abstract
A frequently asked question of hepatologists is, “What is the real value of branched chain amino acids (BCAAs) in portal-systemic encephalopathy (PSE)?”. Despite the publication of a number of randomized clinical trials (RCTs), the answer remains uncertain. BCAAs were introduced for the treatment of PSE on the basis of several observations. First, many investigators had reported that plasma concentrations of BCAA (leucine, valine, isoleucine) are greatly reduced in patients with PSE, ranging from 40 to 80% of normal levels (1–4). Second, plasma levels of the aromatic amino acids (AAA), tyrosine, phenylalanine and tryptophan, have been shown to be elevated (25% to 200% above normal concentrations) (1–3,5). This imbalance results in an abnormally low plasma BCAA/AAA ratio (1.0 to 1.5), which is normally >3.0.
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Conn, H.O., Eriksson, L.S. (1989). Nutritional Therapy of Portal-Systemic Encephalopathy: The Branched Chain Amino Acid Story. In: Butterworth, R.F., Layrargues, G.P. (eds) Hepatic Encephalopathy. Experimental Biology and Medicine, vol 22. Humana Press. https://doi.org/10.1007/978-1-4612-4506-3_35
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DOI: https://doi.org/10.1007/978-1-4612-4506-3_35
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