title: Covert and Overt Hepatic Encephalopathy: Diagnosis and Management.
abstract: Hepatic encephalopathy (HE) is part of a spectrum of neurocognitive changes in cirrhosis. HE is divided into 2 broad categories based on severity: covert hepatic encephalopathy (CHE) and overt hepatic encephalopathy (OHE). CHE has a significant impact on a patient's quality of life, driving performance, and recently has been associated with increased hospitalizations and death. Likewise, OHE is associated with increased rates of hospitalizations and mortality, and poor quality of life. Given its significant burden on patients, care takers, and the health care system, early diagnosis and management are imperative. In addition, focus also should be directed on patient and family member education on the disease progression and adherence to medications. Treatment strategies include the use of nonabsorbable disaccharides, antibiotics (ie, rifaximin), and, potentially, probiotics. Other therapies currently under further investigation include L-ornithine-L-aspartate, ornithine phenylacetate, glycerol phenylbutyrate, molecular adsorbent recirculating system, and albumin infusion.
authors.affiliation: Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University and McGuire VA Medical Center, Richmond, Virginia.
authors.forename: Kavish R
authors.initials: KR
authors.lastname: Patidar
authors.affiliation: Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University and McGuire VA Medical Center, Richmond, Virginia. Electronic address: jsbajaj@vcu.edu.
authors.forename: Jasmohan S
authors.initials: JS
authors.lastname: Bajaj
mesh_terms: D004358:Drug Therapy / Q000379:methods; D042241:Early Diagnosis; D006501:Hepatic Encephalopathy / Q000175:diagnosis* / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D055118:Medication Adherence; D055502:Secondary Prevention / Q000379:methods
keywords: Ammonia; Cirrhosis; Covert Hepatic Encephalopathy; Hepatic Encephalopathy; Lactulose; Overt Hepatic Encephalopathy; Rifaximin