Emerging Therapies for the Management of Hepatic Encephalopathy

Abstract

Effective treatment options for hepatic encephalopathy (HE) are limited. Conventional therapeutic approaches are directed at reducing bacterial production of ammonia and enhancing its elimination. Nonabsorbable disaccharides are first-line therapy for HE, but published clinical studies evaluating their safety and efficacy are limited, and patient tolerance of these agents is poor. Recent data from several clinical studies support the use of rifaximin, an oral, minimally absorbed antibiotic. Rifaximin appears to be well tolerated and to confer therapeutic benefits at least comparable with, and possibly exceeding, those of nonabsorbable disaccharides and systemic antibiotics. Other potentially useful pharmacotherapies under study include acarbose, levocarnitine, and probiotics. In hospitalized patients with severe HE, the use of liver support devices (e.g., molecular adsorbent recirculating system) in the treatment of HE has shown promise in early-stage clinical investigation.