Abstract
Hepatic encephalopathy (HE) is a common complication of advanced liver disease which has profound implications in terms of the patients’ ability to fulfil their family and social roles, to drive and to provide for themselves. Recurrent and persistent HE is still a serious management challenge, translating into a significant burden for patients and their families, health services and society at large. The past few years have been characterized by significantly more attention towards HE and its implications; its definition has been refined and a small number of new drugs/alternative management strategies have become available, while others are underway. In this narrative review we summarize them in a pragmatic and hopefully useful fashion.
Highlights
The 2018–2021 literature search was conducted on Pubmed using the terms hepatic encephalopathy plus: treatment, polyethylene glycol (PEG), branched-chain amino acids (BCAAs), L-ornithine L-aspartate (LOLA), nitrogen scavengers, Acetyl L-carnitine, albumin, probiotics, fecal microbiota transplantation (FMT), flumazenil, minocycline, ibuprofen, phosphodiesterase-5 inhibitors, indomethacin, benzodiazepine inverse agonists
A double-blind randomised controlled trial (RCT) showed that LOLA was superior to placebo in the secondary prophylaxis of overt Hepatic encephalopathy (HE) in 150 patients with cirrhosis [25]; improvement in psychometric test scores, critical flicker frequency and quality of life were documented, together with significant reductions in arterial ammonia levels
Blood ammonia lowering was documented in patients receiving acetyl-L-carnitine, it was not associated with any obvious clinical benefit
Summary
HE is classified as episodic, recurrent (more than one episode over a period of six months) or persistent (no return to normal/baseline neuropsychiatric performance in between episodes) [1] This narrative review will deal with the management of Type C HE, i.e., the one associated with cirrhosis with or without portal-systemic shunt [1]. The 2018–2021 literature search was conducted on Pubmed using the terms hepatic encephalopathy plus: treatment, polyethylene glycol (PEG), branched-chain amino acids (BCAAs), L-ornithine L-aspartate (LOLA), nitrogen scavengers, Acetyl L-carnitine, albumin, probiotics, fecal microbiota transplantation (FMT), flumazenil, minocycline, ibuprofen, phosphodiesterase-5 inhibitors, indomethacin, benzodiazepine inverse agonists.
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