This commissioned article was subject to full peer-review.
Review article: the modern management of hepatic encephalopathy
Article first published online: 7 DEC 2009
© 2010 Blackwell Publishing Ltd
Alimentary Pharmacology & Therapeutics
Volume 31, Issue 5, pages 537–547, March 2010
How to Cite
BAJAJ, J. S. (2010), Review article: the modern management of hepatic encephalopathy. Alimentary Pharmacology & Therapeutics, 31: 537–547. doi: 10.1111/j.1365-2036.2009.04211.x
- Issue published online: 1 FEB 2010
- Article first published online: 7 DEC 2009
- Publication data Submitted 5 October 2009 First decision 19 October 2009 Resubmitted 19 November 2009 Accepted 2 December 2009 Epub Accepted Article 7 December 2009
Aliment Pharmacol Ther 31, 537–547
Background Hepatic encephalopathy, both overt and minimal, forms a continuum of cognitive change in cirrhosis. Strategies to diagnose and treat hepatic encephalopathy have evolved considerably.
Aim To examine the updated diagnostic and treatment strategies for hepatic encephalopathy.
Methods Techniques for the clinical, psychometric and neurophysiological evaluation of hepatic encephalopathy are reviewed. The methods reviewed include pure clinical scales (West-Haven), psychometric tests (PSE-syndrome test), neurophysiological tests (EEG, Critical flicker frequency, CFF) and computerized tests (Inhibitory control test, ICT).
Results Clinical scales are limited, whereas psychometric tests (specifically PSE-syndrome test), CFF and ICT can be used to diagnose minimal hepatic encephalopathy. However, there is no single test that can capture the entire spectrum of cognitive impairment. Treatment options and goals depend on the acuity of hepatic encephalopathy. In-patient management should concentrate on supportive care, precipitating factor reversal and lactulose and/or rifaximin therapy. Out-patient therapy should aim to prevent recurrences, and both lactulose and rifaximin have evidence to support their use.
Conclusions Diagnostic techniques for hepatic encephalopathy range from simple scales to sophisticated tools. Treatment options depend on the stage of hepatic encephalopathy. The future challenge is to evaluate cognitive function as a continuum with clinically relevant outcomes and to develop well-tolerated and inexpensive treatments for hepatic encephalopathy.