Management of covert hepatic encephalopathy

Abstract

Hepatic encephalopathy is a reversible progressive neuropsychiatric disorder that encompasses a wide clinical spectrum. Covert hepatic encephalopathy is defined as patients with minimal hepatic encephalopathy and Grade I encephalopathy by West-Haven Criteria. Terminology such as "sub-clinical", "latent", and "minimal" appear to trivialize the disease and have been replaced by the term covert. The lack of clinical signs means that covert hepatic encephalopathy is rarely recognized or treated outside of clinical trials with options for therapy based on patients with episodic hepatic encephalopathy. This review discusses the current available options for therapy in covert hepatic encephalopathy and focuses on non-absorbable disacharides (lactulose or lactitol), antibiotics (rifaximin), probiotics/synbiotics and l-ornithine-l-aspartate.

Keywords: APT, abnormal psychometric testing; BAEP, brain auditory evoked potential; BDT, block design test; CFF, critical flicker frequency; DST, digit symbol test; FCT-A, Figure connection test-A; FOS, fructo-oligosaccharides; HRQoL, health-related quality of life; ICT, inhibitory control test; LCT, line tracing test; NCT-A, number connection tests A; NCT-B, number connection tests B; NPE, neuropsychological exam; OCTT, orocecal transit time; PCT, Picture completion test; PSE, psychometric testing; RCT, race track test; SDMT, Symbol digit modalities test; SDT, serial-dotting test; SPT, standard psychometric test; TMT, Trail making test; hepatic encephalopathy; lactulose; probiotics; rifaximin.