Treatment Options for Covert Hepatic Encephalopathy
Hepatic encephalopathy, even in its mildest form, can lead to significant deterioration in quality of life, lower overall survival, and add to caregiver burden. However, due to a paucity of symptoms, covert hepatic encephalopathy (CHE) is often ignored or neglected by physicians as well as patients. The lack of consensus among experts for both diagnosis as well as treatment of CHE adds to this problem. Treatment options for CHE include lactulose, rifaximin, ammonia scavengers, branched-chain amino acids, and probiotics. In this chapter we review the existing evidence on these agents and explain treatment decisions using a case-based approach.
KeywordsCovert hepatic encephalopathy Portosystemic shunt Psychometric hepatic encephalopathy score Minimal hepatic encephalopathy
American Association for the Study of Liver Diseases
Branched-chain amino acids
Critical flicker frequency
Covert hepatic encephalopathy
European Association for the Study of the Liver
Model for end-stage liver disease
Mini-mental state examination
Overt hepatic encephalopathy
Psychometric hepatic encephalopathy score
Spontaneous bacterial peritonitis
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