Evidence-based approach to management of hepatic encephalopathy in adults

Abstract

Hepatic encephalopathy (HE) is a reversible syndrome of impaired brain function and represents one of the many complications of portal hypertension and decompensated liver disease. Although ammonia is clearly implicated in the pathogenesis of HE, the pathogenesis of HE is multifactorial with numerous mechanisms that results in functional impairment of neuronal cells. The initial management of HE focuses on supportive care and stabilization which includes providing appropriate nutritional support. Thereafter, focus should be on identifying and treating the precipitating factors. There are many therapeutic agents available for the management of HE, most of which are directed towards lowering the gut nitrogen load and thus the serum ammonia level. This review aims to provide an update on the conventional and emerging treatment options for HE.

Keywords: Hepatic encephalopathy; Lactulose; Rifaximin; Fecal microbiota transplant; Zinc; L-ornithine L-aspartate

Core Tip: Hepatic encephalopathy (HE) is a reversible syndrome of impaired brain function and represents one of the many complications of portal hypertension and decompensated liver disease. This review provides an update on the conventional and emerging treatment options for HE. The different conventional and emerging therapeutic options available to date are detailed in the manuscript. We have elaborated all the data available in the literature about the use of fecal microbiota transplant in the treatment of HE.