ACG Clinical Guideline: Hepatic Encephalopathy

Area of Science:

• Gastroenterology
• Hepatology
• Clinical Practice Guidelines

Background:

• Hepatic encephalopathy (HE) is a serious complication of cirrhosis, affecting patients, families, and healthcare systems.
• Current liver transplant criteria may not adequately reflect HE progression and its impact on quality of life.
• This highlights a gap in prioritizing patients for transplantation despite significant functional impairment.

Purpose of the Study:

• To provide comprehensive, evidence-based recommendations for the diagnosis of hepatic encephalopathy.
• To outline effective management strategies for patients with hepatic encephalopathy.
• To present guidelines for the prevention of hepatic encephalopathy in cirrhosis patients.

Main Methods:

• Development of 24 recommendations based on the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework.
• Systematic review and appraisal of evidence quality for each recommendation.
• Inclusion of key concepts for statements not assessed by the GRADE process.

Main Results:

• The guideline presents 24 distinct recommendations covering diagnosis, management, and prevention of hepatic encephalopathy.
• Evidence quality was rigorously assessed using the GRADE methodology.
• Key concepts are provided to supplement the GRADE-assessed statements.

Conclusions:

• Hepatic encephalopathy requires a structured approach to diagnosis, management, and prevention in cirrhosis.
• The guideline aims to improve patient care and potentially inform transplant prioritization.
• Adherence to these recommendations can mitigate the burden of hepatic encephalopathy.