Hepatic encephalopathy: how to test and treat.
OBJECTIVE
Hepatic encephalopathy causes significant cognitive impairment and morbidity in patients with cirrhosis; however, hepatic encephalopathy is considered a reversible syndrome once recognized clinically. Although hepatic encephalopathy is not a single clinical entity, the pathophysiology resulting in brain dysfunction is not fully understood, although it is believed that ammonia production is an important contributing factor. The purpose of this review is to highlight studies used to test for hepatic encephalopathy and those utilizing specific new treatments.


RESULTS
A 'STROOP' smartphone app has been developed to allow clinicians to test for covert hepatic encephalopathy (CHE). Lactulose therapy was effective for cirrhotic patients as primary prophylaxis to prevent overt hepatic encephalopathy (OHE) episodes. In patients without prior OHE, probiotics can be useful in preventing OHE. Lactulose, probiotics, L-ornithine-L-aspartate, and potassium-iron-phosphate-citrate have been studied in the treatment of CHE. Rifaximin was found to be safe and well tolerated in long-term maintenance of remission from OHE; however, compared to lactulose therapy in CHE, it is not cost-effective.


CONCLUSIONS
Refinement in clinical management strategies for patients with cirrhosis and hepatic encephalopathy appears to continue to contribute to improved patient outcomes.
aAnnette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, Texas bDepartment of Internal Medicine, Medical University of South Carolina, Charleston, South Carolina, USA.
Robert S
RS
Rahimi
Don C
DC
Rockey
D003072:Cognition Disorders / Q000209:etiology; D005765:Gastrointestinal Agents / Q000627:therapeutic use; D006501:Hepatic Encephalopathy / Q000175:diagnosis* / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D006801:Humans; D063731:Mobile Applications; D019936:Probiotics / Q000627:therapeutic use; D012294:Rifamycins / Q000627:therapeutic use; D000078262:Rifaximin; D009626:Terminology as Topic
D005765:Gastrointestinal Agents; D012294:Rifamycins; D000078262:Rifaximin