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Management of covert hepatic encephalopathy
Abhijeet Waghray1, Nisheet Waghray2, Kevin Mullen2
1Department of Medicine, MetroHealth Medical Center/Case Western Reserve University, 2500 MetroHealth Drive, Cleveland, OH 44109, USA.
Journal of Clinical and Experimental Hepatology
|June 5, 2015
Summary
Covert hepatic encephalopathy, a subtle neuropsychiatric disorder, often goes unrecognized. This review details therapeutic options including non-absorbable disaccharides, antibiotics, probiotics, and L-ornithine-L-aspartate for this condition.
Area of Science:
- Hepatology
- Neurology
- Gastroenterology
Background:
- Hepatic encephalopathy (HE) is a reversible neuropsychiatric disorder.
- Covert hepatic encephalopathy (CHE) refers to minimal or Grade I HE by West-Haven Criteria.
- CHE is often unrecognized due to a lack of overt clinical signs.
Purpose of the Study:
- To review current therapeutic options for covert hepatic encephalopathy.
- To highlight treatments beyond those used in clinical trials for episodic HE.
Main Methods:
- Literature review of therapeutic strategies for CHE.
- Focus on non-absorbable disaccharides, antibiotics, probiotics/synbiotics, and L-ornithine-L-aspartate.
Main Results:
- Non-absorbable disaccharides (lactulose, lactitol) are a primary treatment.
- Rifaximin offers an antibiotic option.
- Probiotics/synbiotics and L-ornithine-L-aspartate are also discussed.
Conclusions:
- Effective management of CHE requires recognition and appropriate therapy.
- A range of treatment options are available for covert hepatic encephalopathy.
Keywords:
APT, abnormal psychometric testingBAEP, brain auditory evoked potentialBDT, block design testCFF, critical flicker frequencyDST, digit symbol testFCT-A, Figure connection test-AFOS, fructo-oligosaccharidesHRQoL, health-related quality of lifeICT, inhibitory control testLCT, line tracing testNCT-A, number connection tests ANCT-B, number connection tests BNPE, neuropsychological examOCTT, orocecal transit timePCT, Picture completion testPSE, psychometric testingRCT, race track testSDMT, Symbol digit modalities testSDT, serial-dotting testSPT, standard psychometric testTMT, Trail making testhepatic encephalopathylactuloseprobioticsrifaximin
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