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Hepatic encephalopathy: current challenges and future prospects
#MMPMID29606895
Swaminathan M
; Ellul MA
; Cross TJ
Hepat Med
2018[]; 10
(?): 1-11
PMID29606895
show ga
Hepatic encephalopathy (HE) is a common complication of liver dysfunction,
including acute liver failure and liver cirrhosis. HE presents as a spectrum of
neuropsychiatric symptoms ranging from subtle fluctuating cognitive impairment to
coma. It is a significant contributor of morbidity in patients with liver
disease. HE is observed in acute liver failure, liver bypass procedures, for
example, shunt surgry and transjugular intrahepatic portosystemic shunt, and
cirrhosis. These are classified as Type A, B and C HE, respectively. HE can also
be classified according to whether its presence is overt or covert. The
pathogenesis is linked with ammonia and glutamine production, and treatment is
based on mechanisms to reduce the formation and/or removal of these compounds.
There is no specific diagnostic test for HE, and diagnosis is based on clinical
suspicion, excluding other causes and use of clinical tests that may support its
diagnosis. Many tests are used in trials and experimentally, but have not yet
gained universal acceptance. This review focuses on the definitions, pathogenesis
and treatment of HE. Consideration will be given to existing treatment, including
avoidance of precipitating factors and novel therapies such as prebiotics,
probiotics, antibiotics, laxatives, branched-chain amino acids, shunt
embolization and the importance of considering liver transplant in appropriate
cases.
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