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Review
. 2023 Feb 2;12(3):1187.
doi: 10.3390/jcm12031187.

Old and New Precipitants in Hepatic Encephalopathy: A New Look at a Field in Continuous Evolution

Daniele Bellafante  1 , Stefania Gioia  1 , Jessica Faccioli  1 , Oliviero Riggio  1 , Lorenzo Ridola  1 , Silvia Nardelli  1
Affiliations
Review

Old and New Precipitants in Hepatic Encephalopathy: A New Look at a Field in Continuous Evolution

Daniele Bellafante et al. J Clin Med. .

Abstract

Hepatic encephalopathy (HE) is a common complication in patients with advanced liver disease. It is a brain dysfunction characterized by neurological and psychiatric symptoms that significantly affects quality of life, morbidity and mortality of patients. HE has various precipitants that can potentially promote its onset, alone or in combination. Among the historically well-known precipitants, such as infections, gastrointestinal bleeding, dehydration, electrolyte disorders and constipation, recent studies have highlighted the role of malnutrition and portosystemic shunts as new precipitating factors of HE. The identification, management and correction of these factors are fundamental for effective HE treatment, in addition to pharmacological therapy with non-absorbable disaccharides and/or antibiotics.

Keywords: ammonia; liver cirrhosis; minimal hepatic encephalopathy; overt hepatic encephalopathy; portosystemic shunts; sarcopenia.

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Conflict of interest statement

The authors declare no conflict of interest.

References

    1. Vilstrup H., Amodio P., Bajaj J., Cordoba J., Ferenci P., Mullen K.D., Weissenborn K., Wong P. Hepatic encephalopathy in chronic liver disease: 2014 Practice Guideline by the American Association for the Study of Liver Diseases and the European Association for the Study of the Liver. Hepatology. 2014;60:715–735. doi: 10.1002/hep.27210. - DOI - PubMed
    1. Montagnese S., Russo F.P., Amodio P., Burra P., Gasbarrini A., Loguercio C., Marchesini G., Merli M., Ponziani F.R., Riggio O., et al. Hepatic encephalopathy 2018: A clinical practice guideline by the Italian Association for the Study of the Liver (AISF) Dig. Liver Dis. 2019;51:190–205. doi: 10.1016/j.dld.2018.11.035. - DOI - PubMed
    1. European Association for the Study of the Liver EASL Clinical Practice Guidelines on the management of hepatic encephalopathy. J. Hepatol. 2022;77:807–824. doi: 10.1016/j.jhep.2022.06.001. - DOI - PubMed
    1. Elsaid M.I., Rustgi V.K. Epidemiology of Hepatic Encephalopathy. Clin. Liver Dis. 2020;24:157–174. doi: 10.1016/j.cld.2020.01.001. - DOI - PubMed
    1. Poordad F.F. Review article: The burden of hepatic encephalopathy. Aliment. PharmacolTher. 2007;25((Suppl. S1)):3–9. doi: 10.1111/j.1746-6342.2006.03215.x. - DOI - PubMed

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