Patients with hepatic encephalopathy have low levels of enteral branched-chain amino acids (BCAAs) and increased levels of phenylalanine and tryptophane. It has been postulated that since BCAAs compete with phenylalanine and trypto-phane for transport through the blood-brain barrier, reduced levels of BCAAs promote the accumulation of these amino acids in the brain, where they are metabolized to false neurotransmitters that then cause encephalopathy. To reverse this state, BCAA-enriched formulas were developed, and in a meta-analysis of randomized controlled trials of these formulations in hepatic encephalopathy, they were shown to reduce the duration of encephalopathy in comatose patients.
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