title: Optimal treatment of hepatic encephalopathy.
abstract: Hepatic encephalopathy (HE) is a neuropsychiatric complication of acute or chronic liver disease with symptoms encompassing a continuum from mild confusion to coma. Both covert and overt HE have a significant impact on quality of life and healthcare related costs. The pathophysiology of HE is multifactorial and there is general consensus that ammonia and inflammation act synergistically to cause astrocyte swelling and cerebral edema. Current management strategies include the identification of precipitating factors and the initiation of pharmacologic therapies aimed at modulating intestinal flora and reducing levels of ammonia and other gut-derived toxins. Lactulose and rifaximin are two commonly used treatments for the management of HE. This article will review the optimal management of hepatic encephalopathy.
authors.affiliation: Department of Medicine MetroHealth Medical Center Case Western Reserve University Cleveland, OH, USA - awaghray@metrohealth.org.
authors.forename: A
authors.initials: A
authors.lastname: Waghray
authors.forename: N
authors.initials: N
authors.lastname: Waghray
authors.forename: S
authors.initials: S
authors.lastname: Kanna
authors.forename: K
authors.initials: K
authors.lastname: Mullen
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D019317:Evidence-Based Medicine; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D006501:Hepatic Encephalopathy / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D007792:Lactulose / Q000627:therapeutic use*; D008103:Liver Cirrhosis / Q000150:complications*; D017410:Practice Guidelines as Topic; D019936:Probiotics / Q000627:therapeutic use; D011788:Quality of Life; D012294:Rifamycins / Q000627:therapeutic use*; D000078262:Rifaximin; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014481:United States
chemical_list: D000900:Anti-Bacterial Agents; D005765:Gastrointestinal Agents; D012294:Rifamycins; D007792:Lactulose; D000078262:Rifaximin