Management of Hepatic Encephalopathy Associated with Advanced Liver Disease

Abstract

Hepatic encephalopathy (HE) is a very prevalent condition in patients with advanced liver disease and has a high recurrence rate. The pathophysiology has a multifactorial origin where hyperammonaemia and inflammation become particularly relevant. There are no HE-specific diagnostic tests, and diagnosis is usually made by taking into account the presence of suggestive and compatible clinical symptoms, the existence of a predisposing liver condition and ruling out other causes with similar clinical manifestations. Once the diagnosis of HE is established, it is essential to carry out an adequate classification based on the underlying liver disease, the intensity of clinical manifestations, the temporal course of the disease and the presence or absence of precipitating factors. Treatment should be aimed at decreasing the duration, intensity and consequences of episodes, preventing recurrence and limiting the impact of the disease in patients and their relatives.

Fig. 1

Hepatic encephalopathy classification. HE hepatic encephalopathy, MHE minimal hepatic encephalopathy

Fig. 2

Steps to diagnosing a possible hepatic encephalopathy and treatment algorithm. ABC airway, breathing, circulation, AoCLF acute-on-chronic liver failure, BZD benzodiazepines, HE hepatic encephalopathy, LT liver transplantation, NADs non-absorbable disaccharides, RCT randomized controlled trial