New approaches to correction of hyperammonemia in patients with non-alcohol steatohepatitis – liquidators of consequences of the accident at Chernobyl APP and personnel of the Federal Fire Service of the EMERCOM of Russia

Relevance. The relevance of this study is determined by the need to correct hyperammonemia in patients with diffuse liver diseases at the pre-cirrhotic stage, since elevated levels of ammonia in the serum have toxic effects on the central nervous system, with the development of hepatic encephalopathy.

Intention. To evaluate current medication options for correction of hyperammonemia in chronic non-alcoholic steatohepatitis in the liquidators of the consequences of the accident at the Chernobyl nuclear power plant (NPP) and personnel of the Federal Fire Service (FFS) of the Emercom of Russia.

Methodology. 34 liquidators of consequences of the accident at the Chernobyl NPP nuclear power plant and 38 employees of the FFS of the Emercom of Russia underwent clinical and laboratory studies, including ammonia levels in blood plasma by enzyme method, evaluation of microbiota disorders, and liver fibrosis grade before and after treatment with L-ornithine-Laspartate (LOLA), as well as a combination of lactulose and a course of rifaximin.

Results and Discussion. After correction of hyperammonemia in patients with chronic non-alcoholic steatohepatitis – the liquidators of the consequences of the Chernobyl accident and personnel of the FFS of the Emercom of Russia, there was a decrease in the clinical manifestations of asthenovegetative and dyspeptic syndromes; the incidence of cytolytic and cholestatic syndromes. Besides, intestinal microbiota disorder decreased, as well as fibrotic changes in the liver, and the severity of intrahepatic hemodynamics disorder. In previous studies, the correction of hyperammonemia was mainly carried out with LOLA or lactulose.

Conclusion. All liquidators of the consequences of the Chernobyl accident and employees of the FFS of the Emercom of Russia with chronic non-alcoholic steatohepatitis and hyperammonemia should undergo its correction. LOLA is most effective in case of non-cirrhotic portal hypertension and the development of minimal hepatic encephalopathy, and a combination of rifaximin and lactulose is most effective if the intestinal dysbiosis prevails.

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