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In a phase I study in cirrhotic patients, the adverse effects were mild and blood ammonia concentration decreased by 50% in 36 h under continuous infusion.29 Flumazenil has been posed as an alternative in HE because of its anti-GABAergic activity, but a meta-analysis recently published does conclude neither in mortality decrease nor in clinical improvement in patients with HE.44 Flumazenil may be considered for selected patients with HE and chronic liver disease.31 Activated carbon microparticles have been shown to decrease intestinal ammonia absorption and thus lower ammonia blood concentration in animals and humans.29 Gene therapy is the future of genetic disease therapy

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