[Hepatic encephalopathy in liver cirrhosis]

Area of Science:

• Hepatology
• Neurology
• Gastroenterology

Background:

• Hepatic encephalopathy (HE) is a severe complication of liver cirrhosis.
• It significantly increases morbidity and mortality.
• Pathophysiology involves hyperammonemia, inflammation, and microbial dysbiosis.

Purpose of the Study:

• To outline the pathophysiology, clinical presentation, and diagnosis of HE.
• To review current treatment strategies for acute and chronic HE.
• To emphasize the importance of early detection and individualized management.

Main Methods:

• Clinical assessment and specialized testing for diagnosis.
• Review of established pharmacological treatments (lactulose, L-ornithine-L-aspartate, rifaximin).
• Consideration of nutritional support and liver transplantation.

Main Results:

• HE presents a spectrum from minimal cognitive impairment to coma.
• Ammonia levels have limited diagnostic utility but aid in differential diagnosis.
• Lactulose is the primary treatment for overt HE and prophylaxis; rifaximin is used for recurrent episodes.

Conclusions:

• Individualized management, including nutritional recommendations, is crucial.
• Liver transplantation should be considered for refractory cases.
• Early detection and tailored treatment improve quality of life and prognosis.