Hepatic encephalopathy: current challenges and future prospects

• Published in: Hepatic medicine: evidence and research Vol. 10; pp. 1 - 11
• Main Authors: Swaminathan, Mirashini, Ellul, Mark Alexander, Cross, Timothy Js
• Format: Journal Article
• Language: English
• Published: New Zealand Dove Medical Press Limited 01.01.2018; Taylor & Francis Ltd; Dove Medical Press
• Subjects: Activities of daily living; Amino acids; Ammonia; Analysis; Animal cognition; Branched chain amino acids; Care and treatment; Cognitive ability; Coma; Coronary artery bypass; Dosage and administration; Encephalopathy; Gastroenterology; Gastrointestinal agents; Gene expression; Glutamine; Hepatic encephalopathy; Hepatology; Lactulose; Liver; Liver cirrhosis; Liver diseases; Liver encephalopathy; Liver failure; Liver transplantation; Malnutrition; Medical prognosis; Microbiota; Morbidity; Musculoskeletal system; Novels; Organ transplantation; Pathogenesis; Patient outcomes; probiotics; Quality of life; Review; Rifaximin; Sarcopenia; Surgery; Systematic review; treatment; United Kingdom > UK; pathogenesis; treatment; covert hepatic encephalopathy; hepatic encephalopathy; lactulose; rifaximin; probiotics
• ISSN: 1179-1535; 1179-1535
• DOI: 10.2147/hmer.s118964

Hepatic encephalopathy (HE) is a common complication of liver dysfunction, including acute liver failure and liver cirrhosis. HE presents as a spectrum of neuropsychiatric symptoms ranging from subtle fluctuating cognitive impairment to coma. It is a significant contributor of morbidity in patients with liver disease. HE is observed in acute liver failure, liver bypass procedures, for example, shunt surgry and transjugular intrahepatic portosystemic shunt, and cirrhosis. These are classified as Type A, B and C HE, respectively. HE can also be classified according to whether its presence is overt or covert. The pathogenesis is linked with ammonia and glutamine production, and treatment is based on mechanisms to reduce the formation and/or removal of these compounds. There is no specific diagnostic test for HE, and diagnosis is based on clinical suspicion, excluding other causes and use of clinical tests that may support its diagnosis. Many tests are used in trials and experimentally, but have not yet gained universal acceptance. This review focuses on the definitions, pathogenesis and treatment of HE. Consideration will be given to existing treatment, including avoidance of precipitating factors and novel therapies such as prebiotics, probiotics, antibiotics, laxatives, branched-chain amino acids, shunt embolization and the importance of considering liver transplant in appropriate cases.