Hepatic Encephalopathy Challenges, Burden, and Diagnostic and Therapeutic Approach

Beshoy Yanny; Adam Winters; Sandra Boutros; Sammy Saab

doi:10.1016/j.cld.2019.07.001

Hepatic Encephalopathy Challenges, Burden, and Diagnostic and Therapeutic Approach

Clin Liver Dis. 2019 Nov;23(4):607-623. doi: 10.1016/j.cld.2019.07.001. Epub 2019 Aug 31.

Authors

Beshoy Yanny¹, Adam Winters², Sandra Boutros³, Sammy Saab⁴

Affiliations

¹ Department of Medicine, University of California at Los Angeles, 1223 16th street, suite 3100, Santa Monica, CA 90404, USA. Electronic address: byanny@mednet.ucla.edu.
² Department of Medicine, University of California at Los Angeles, 1223 16th street, suite 3100, Santa Monica, CA 90404, USA.
³ Department of Surgery, University of California at Los Angeles, 200 medical plaza, 3rd floor, Los Angeles, CA 90095, USA.
⁴ Department of Medicine, University of California at Los Angeles, 1223 16th street, suite 3100, Santa Monica, CA 90404, USA; Department of Surgery, University of California at Los Angeles, 200 medical plaza, 3rd floor, Los Angeles, CA 90095, USA; Department of Nursing, University of California at Los Angeles, 200 medical plaza, 3rd floor, Los Angeles, CA 90095, USA.

PMID: 31563214
DOI: 10.1016/j.cld.2019.07.001

Abstract

Hepatic encephalopathy (HE) is an important cause of morbidity and mortality in patients with cirrhosis. The impact of HE on the health care system is similarly profound. The number of hospital admissions for HE has increased in the last 10-year period. HE is a huge burden to the patients, care givers, and the health care system. HE represents a "revolving door" with readmission, severely affects care givers, and has effects on cognition that can persists after liver transplant. This article reviews the current literature to discuss the challenges and diagnostic and therapeutic approaches to HE.

Keywords: Hepatic encephalopathy; Liver cirrhosis; Portal hypertension; Refractory hepatic encephalopathy.

Publication types

Review

MeSH terms

Amino Acids, Branched-Chain / therapeutic use
Ammonia / metabolism
Caregivers
Cost of Illness
Dipeptides / therapeutic use
Embolization, Therapeutic / methods*
Gastrointestinal Agents / therapeutic use*
Hepatic Encephalopathy / diagnosis
Hepatic Encephalopathy / epidemiology
Hepatic Encephalopathy / therapy*
Hospitalization
Humans
Lactulose / therapeutic use
Neomycin / therapeutic use
Patient Readmission
Rifaximin / therapeutic use
Severity of Illness Index
Sodium Benzoate / therapeutic use
Sorption Detoxification / methods*
Zinc / therapeutic use

Substances

Amino Acids, Branched-Chain
Dipeptides
Gastrointestinal Agents
Lactulose
Ammonia
Neomycin
Zinc
ornithylaspartate
Rifaximin
Sodium Benzoate