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Current Management of Hepatic Encephalopathy

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Abstract

Purpose of Review

Hepatic encephalopathy (HE) is a complication of liver dysfunction and portosystemic shunting. The purpose of this review is to discuss the management of HE.

Recent Findings

Traditional therapies include lactulose and rifaximin, but other treatment options have recently emerged. Branched chain amino acids are involved in the Krebs cycle and have an inverse relationship with ammonia. Flumazenil, a benzodiazepine antagonist, has a negative effect on the gamma-aminobutyric acid receptor, which plays a role in cognitive deficits. Because of microbiome changes, fecal microbiota transplantation and probiotics are emerging therapeutic considerations.

Summary

Despite multiple therapies for HE, the emerging options have shown varying degrees of evidence. Future studies are needed to examine the impact of each therapy on the different grades of HE, as most studies showed benefit for primarily lower grades. Future studies should also investigate whether certain therapeutic combinations are favored.

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Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, Mayo Clinic Arizona, 5777 East Mayo Boulevard., Phoenix, AZ, 85254, USA

    Margaret C. Liu, David M. H. Chascsa & Blanca Lizaola-Mayo

  2. Department of Internal Medicine, Charleston Area Medical Center/West Virginia University Charleston Division, Charleston, USA

    Julton Tomanguillo Chumbe

  3. Transplant Center, Mayo Clinic Arizona, 5777 East Mayo Boulevard., Phoenix, AZ, 85254, USA

    David M. H. Chascsa & Blanca Lizaola-Mayo

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  1. Margaret C. Liu
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Contributions

B.L.M. and D.M.H.C. designed the outline and reviewed and edited the manuscript and figure. M.C.L. and J.T.C. wrote the main manuscript text and prepared the figure.

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Correspondence to Blanca Lizaola-Mayo.

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Liu, M.C., Chumbe, J.T., Chascsa, D.M.H. et al. Current Management of Hepatic Encephalopathy. Curr Hepatology Rep 23, 73–80 (2024). https://doi.org/10.1007/s11901-023-00627-2

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