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Reducing the Risk of Overt Hepatic Encephalopathy Recurrence: A Narrative Review
Nikolaos T Pyrsopoulos1, Nadege Gunn2, Prasun K Jalal3
1NYU Langone Transplant Institute, Langone Health, and Grossman School of Medicine, New York, NY, USA.
Journal of Clinical and Translational Hepatology
|July 22, 2026
Summary
Hepatic encephalopathy (HE) management involves identifying triggers and using therapies like lactulose and rifaximin. Reducing recurrence risk in cirrhosis patients is key for better quality of life.
Area of Science:
- Hepatology
- Neurology
- Gastroenterology
Background:
- Hepatic encephalopathy (HE) is a severe neurologic complication of advanced liver disease, impacting patient quality of life and prognosis.
- HE significantly burdens patients, caregivers, and healthcare systems due to increased hospitalizations and mortality.
Purpose of the Study:
- To review the burden, precipitating factors, and management strategies for overt HE (OHE) recurrence in adults with cirrhosis.
- To discuss current and investigational treatments for reducing OHE recurrence.
Main Methods:
- This narrative review synthesizes information on HE burden, risk factors, and clinical management.
- Evidence from clinical guidelines and investigational studies on HE treatments was considered.
Main Results:
- Key precipitating factors for HE include medications, constipation, dehydration, infections, and sarcopenia.
- Lactulose is recommended for secondary prophylaxis, with rifaximin as add-on therapy. Investigational treatments include L-ornithine-L-aspartate, nitazoxanide, and FMT.
Conclusions:
- Effective HE management requires identifying and treating precipitating factors.
- Ongoing care, including education, nutrition, and pharmacotherapy, is crucial for preventing OHE recurrence in cirrhosis patients.
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