Current vision on diagnosis and comprehensive care in hepatic encephalopathy

Abstract

The first clinical guidelines on hepatic encephalopathy were published in 2009. Almost 14 years since that first publication, numerous advances in the field of diagnosis, treatment, and special condition care have been made. Therefore, as an initiative of the Asociación Mexicana de Gastroenterología A.C., we present a current view of those aspects. The manuscript described herein was formulated by 24 experts that participated in six working groups, analyzing, discussing, and summarizing the following topics: Definition of hepatic encephalopathy; recommended classifications; epidemiologic panorama, worldwide and in Mexico; diagnostic tools; conditions that merit a differential diagnosis; treatment; and primary and secondary prophylaxis. Likewise, these guidelines emphasize the management of certain special conditions, such as hepatic encephalopathy in acute liver failure and acute-on-chronic liver failure, as well as specific care in patients with hepatic encephalopathy, such as the use of medications and types of sedation, describing those that are permitted or recommended, and those that are not.

Keywords: Ammonia; Amoniaco; Critical flicker frequency; Encefalopatía hepática manifiesta; Encefalopatía hepática mínima; Frecuencia crítica de parpadeo; L-ornithine L-aspartate; L-ornitina L-aspartato; Lactulosa; Lactulose; Minimal hepatic encephalopathy; Overt hepatic encephalopathy; Prueba de interferencia semántica; Psychometric hepatic encephalopathy score; Puntaje psicométrico para encefalopatía hepática; Rifaximin; Rifaximina; Stroop test.