Hepatic encephalopathy: nomenclature, pathogenesis and treatment.
Hepatic encephalopathy (HE) is a neuropsychiatric syndrome in patients with liver failure and/or a portal-systemic bypass. Since 2002 a new nomenclature of HE exists, that classifies HE in encephalopathy type A (associated with acute liver failure), type B (associated with portal-systemic bypass), and type C (associated with liver cirrhosis). HE type A is characterized by a rapid development to coma, cerebral edema, and a poor short-term prognosis. Therefore, these patients should be referred to a liver transplantation center. Standard treatment of HE consists of non absorbable disaccharides, non absorbable antibiotics, and a diet with an appropriate amount of proteins. In addition, the possibility of performing a liver transplantation should be evaluated. In patients with intractable HE other alternative treatments adjunct to standard treatment, like zinc, sodium benzoate, ornithine aspartate, branched chain amino acids, flumazenil, and bromocriptine should be considered.
Quero Guillén
J C
JC
Servicio de Aparato Digestivo. Hospital Virgen Macarena. Sevilla. Spain. queroguillen@yahoo.es
Carmona Soria
I
I
García Montes
J M
JM
Jiménez Sáenz
M
M
Herrerías Gutiérrez
J M
JM
D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use; D000935:Antifungal Agents / Q000008:administration & dosage / Q000627:therapeutic use; D001971:Bromocriptine / Q000008:administration & dosage / Q000627:therapeutic use; D004151:Dipeptides / Q000008:administration & dosage / Q000627:therapeutic use; D018491:Dopamine Agonists / Q000008:administration & dosage / Q000627:therapeutic use; D004569:Electroencephalography; D005442:Flumazenil / Q000008:administration & dosage / Q000627:therapeutic use; D018757:GABA Modulators / Q000008:administration & dosage / Q000627:therapeutic use; D005765:Gastrointestinal Agents / Q000008:administration & dosage / Q000627:therapeutic use; D006501:Hepatic Encephalopathy / Q000145:classification / Q000175:diagnosis / Q000178:diet therapy / Q000188:drug therapy / Q000209:etiology; D006801:Humans; D007792:Lactulose / Q000008:administration & dosage / Q000627:therapeutic use; D017114:Liver Failure, Acute / Q000150:complications; D016031:Liver Transplantation; D009355:Neomycin / Q000008:administration & dosage / Q000627:therapeutic use; D009747:Nutritional Physiological Phenomena; D017410:Practice Guidelines as Topic; D011379:Prognosis; D020160:Sodium Benzoate / Q000008:administration & dosage / Q000627:therapeutic use; D009626:Terminology as Topic; D013997:Time Factors; D015032:Zinc / Q000008:administration & dosage / Q000627:therapeutic use
D000900:Anti-Bacterial Agents; D000935:Antifungal Agents; D004151:Dipeptides; D018491:Dopamine Agonists; D018757:GABA Modulators; D005765:Gastrointestinal Agents; D001971:Bromocriptine; D005442:Flumazenil; D007792:Lactulose; D009355:Neomycin; D015032:Zinc; C002939:ornithylaspartate; D020160:Sodium Benzoate