Hepatische Enzephalopathie und Sarkopenie: pathogenetische Bedeutung und therapeutische Implikationen von Ammoniak

Hepatic encephalopathy and sarcopenia are common complications of liver cirrhosis with profound implications on prognosis. The importance of ammonia for the pathogenesis of hepatic encephalopathy (HE) is well known and lowering ammonia levels is an accepted therapeutic principal in managing HE. However, there is emerging evidence that ammonia also plays a key role in development of sarcopenia and might provide a target for future pharmacological therapy against sarcopenia. Due to the high risk of malnutrition and sarcopenia, patients suffering from cirrhosis should be evaluated routinely for their nutritional status and, if at risk, diagnostic measures for sarcopenia should be initiated. While there are well-established pharmacological approaches for the treatment of hepatic encephalopathy, sarcopenia requires a multimodal approach with optimal nutritional counselling and therapy as well as physical exercise.