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Hepatic Encephalopathy: Diagnosis and Management
Lorenzo Ridola1, Jessica Faccioli1, Silvia Nardelli1
1Department of Translational and Precision Medicine, "Sapienza" University of Rome, Rome, Italy.
Journal of Translational Internal Medicine
|January 29, 2021
Summary
Hepatic encephalopathy (HE) is brain dysfunction in liver cirrhosis. Covert HE (CHE), including minimal HE (MHE), shows subtle cognitive changes, while overt HE (OHE) presents with severe neurological symptoms requiring treatment.
Area of Science:
- Hepatology
- Neurology
- Gastroenterology
Background:
- Hepatic encephalopathy (HE) is a spectrum of brain dysfunction in liver cirrhosis.
- Covert HE (CHE), encompassing minimal HE (MHE) and Grade I HE, presents with subclinical cognitive deficits.
- Overt HE (OHE) involves significant neurological and personality changes.
Purpose of the Study:
- To define and differentiate types of hepatic encephalopathy.
- To outline diagnostic approaches for MHE and OHE.
- To review current treatment and prophylaxis strategies for HE.
Main Methods:
- Literature review and synthesis of existing HE classification and treatment guidelines.
- Description of diagnostic criteria, including psychometric tests for MHE and clinical assessment for OHE.
- Analysis of therapeutic interventions for primary and secondary prophylaxis and treatment of OHE.
Main Results:
- CHE (MHE/Grade I HE) is detectable via psychometric/electrophysiological tests, lacking overt clinical signs.
- OHE diagnosis relies on clinical examination and West Haven criteria, with subtypes including Episodic, Recurrent, and Persistent.
- Prophylaxis involves non-absorbable antibiotics (Rifaximin) or disaccharides (Lactulose) for gastrointestinal bleeding.
- OHE treatment focuses on precipitant factor correction and ammonia reduction using Rifaximin and Lactulose.
- Advanced therapies for recurrent/persistent HE include fecal transplantation and shunt revision.
Conclusions:
- Distinguishing between CHE and OHE is crucial for appropriate management.
- Treatment strategies vary based on HE type and severity, emphasizing ammonia reduction and precipitant factor control.
- Individualized treatment plans are essential, particularly for MHE.
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