Hepatic encephalopathy and its management

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Review Paper 01/06/2022
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Hepatic encephalopathy and its management

Nadia Shah, Shaista Imran, Shazia yousaf, Shahzaib, Fatima, Bakhtawar Urooj, Nadia Mehreen, Bushra Aziz, Muhammad Kamran Taj, Muhammad Saleem, Ghazala Taj, Umbreen Zafar
Int. J. Biosci.20( 6), 45-64, June 2022.
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Abstract

Hepatic encephalopathy (HE) is a symptom of decompensated cirrhosis that affects up to half of all individuals with the disease. Approximately 23,000 inpatients are diagnosed with (HE) each year, and internists and subspecialists are frequently responsible for their care. In recent years, the treatment of hospitalized HE patients has evolved. Induction and maintenance of remission are two aspects of treatment. Infection, gastrointestinal bleeding, medicines, or other factors trigger the majority of instances of serious HE. Secondary triggers should be considered in all cases and in most individuals, treatment should begin with a non-absorbable disaccharide. In patients who do not respond to lactulose, rifaximin might be used. Because of its side effects, neomycin is a less preferable option to rifaximin. For patients who do not respond to disaccharides or non-absorbable antibiotics, other therapy such as zinc, l-ornithine–l-aspartate, and branched-chain amino acids can be considered.

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Agrawal A, Sharma BC, Sharma P, Sarin SK. 2012. Secondary prophylaxis of hepatic encephalopathy in cirrhosis: an open-label, randomized controlled trial of lactulose, probiotics, and no therapy.American Journal of Gastroenterology 107(7), 1043-1050.

Ahboucha S, Butterworth RF. 2004. Pathophysiology of hepatic encephalopathy: a new look at GABA from the molecular standpoint.Metabolic Brain Diseases 19, 331-343.

Ahboucha S, Pomier-Layrargues G, Mamer O. 2006. Increased levels of pregnenolone and its neuroactive metabolite allopregnanolone in autopsied brain tissue from cirrhotic patients who died in hepatic coma. Neurochemistry Internation 49(4), 372-378.

Als-Nielsen B, Gluud LL, Gluud C. 2004. Non-absorbable disaccharides for hepatic encephalopathy: systematic review of randomised trials.Brazillian Medical Journal 328, 1046.

Bajaj JS, Cordoba J, Mullen KD, Amodio P, Shawcross DL, Butterworth RF. 2011. The design of clinical trials in hepatic encephalopathy–an International Society for Hepatic Encephalopathy and Nitrogen Metabolism (ISHEN) consensus statement.Aliment Pharmacology Thergiology 33(7), 739-747.

Bajaj JS, Etemadian A, Haffeezullah M, Saeian K. 2007. Testing for minimal hepatic encephalopathy in the United States: an AASLD survey. Hepatology 45(3), 833-834.

Bajaj JS, Hafeezullah M, Franco J. 2008. Inhibitory control test for the diagnosis of minimal hepatic encephalopathy. Gastroenterology 135(5), 1591-1600.

Bajaj JS, Hafeezullah M, Hoffmann RG, Saeian K. 2007. Minimal hepatic encephalopathy: a vehicle for accidents and traffic violations.American Journal of Gastroenterology 102(9), 1903-1909.

Bajaj JS, Hafeezullah M, Hoffmann RG. 2008. Navigation skill impairment: Another dimension of the driving difficulties in minimal hepatic encephalopathy.Hepatology 47(2), 596-604.

Bajaj JS, Heuman DM, Wade JB. 2011. Rifaximin improves driving simulator performance in a randomized trial of patients with minimal hepatic encephalopathy.Gastroenterology 140(2), 478-487.

Bajaj JS, Saeian K, Schubert CM, Hafeezullah M, Franco J, Varma RR. 2009. Minimal hepatic encephalopathy is associated with motor vehicle crashes: The reality beyond the driving test.Hepatology 15.

Bajaj JS, Saeian K, Verber MD. 2007. Inhibitory control test is a simple method to diagnose minimal hepatic encephalopathy and predict development of overt hepatic encephalopathy. American Journal of Gastroenterology 102(4), 754-760.

Bajaj JS, Schubert CM, Heuman DM, Wade JB, Gibson DP, Topaz A. 2010. Persistence of cognitive impairment after resolution of overt hepatic encephalopathy.Gastroenterology 138(7), 2332-2340.

Bajaj JS, Thacker LR, Heuman DM, Fuchs M, Sterling RK, Sanyal AJ. 2013. The stroop smartphone APP is a short and valid method toscreen for minimal hepatic encephalopathy.Hepatology.

Bajaj JS, Wade JB, Gibson DP, Heuman DM, Thacker LR, Sterling RK. 2011. The multi-dimensional burden of cirrhosis and hepatic encephalopathy on patients and caregivers.American Journal of Gastroenterology 106(9), 1646-1653.

Bajaj JS. 2008. Management options for minimal hepatic encephalopathy. Expert Review of Gastroenterology Hepatoloy 2(6), 785-790.

Bajaj JS. 2010. The modern management of hepatic encephalopathy.Alimentry. Pharmacology Thergiology 31(5), 537–547.

Bass NM, Mullen KD, Sanyal A, Poordad F, Neff G, Leevy CB. 2010. Rifaximin treatment in hepatic encephalopathy.England Journal of Medicine 362(12), 1071-1081.

Batshaw ML, MacArthur RB, Tuchman M. 2001. Alternative pathway therapy for urea cycle disorders: twenty years later.Journal of Pediatry 138(1), 46-54.

Bell BP. 2009. Chronic Liver disease in the United States: Disease burden and epidemiology. http://www2.niddk.nih.gov/NR/rdonlyres/527863FE-0E39-47A6-A04F-3A0AE929FEED/0/Bell.pdf.

Blei AT, Córdoba J. 2001. Practice guidelines: hepatic encephalopathy. American Journal of Gastroenterology 96(7), 1968-1976.

Bresci G, Parisi G, Banti S. 1993. Management of hepatic encephalopathy with oral zinc supplementation: a long-term treatment.European Journal of Medicine 2(7), 414-416.

Brusilow SW. 2002. Hyperammonemic encephalopathy.Medicine (Baltimore) 81(3), 240-249.

Burkhard PR, Delavelle J, Du Pasquier R, Spahr L. 2003. Chronic Parkinsonism associated with cirrhosis: a distinct subset of acquired hepatocerebral degeneration.Archology Neurology 60(4), 521-528.

Bustamante J, Rimola A, Ventura PJ, Navasa M, Cirera I, Reggiardo V. 1999. Prognostic significance of hepatic encephalopathy in patients with cirrhosis.Journal of Hepatology 30(5), 890-895.

Butterworth RF. 2011. Editorial: rifaximin and minimal hepatic encephalopathy.American Journal of Gastroenterology 106(2), 317-318.

Butterworth RF. 2003. Pathogenesis of hepatic encephalopathy: new insights from neuroimaging and molecular studies.Journal of Hepatology 9(2), 278-285.

Butterworth RF. 2000. The astrocytic (“peripheral-type”) benzodiazepine receptor: role in the pathogenesis of portal-systemic encephalopathy.Neurochemistry International 36(4-5), 411-416.

Caldwell C, Werdiger N, Jakab S, Schilsky M, Arvelakis A, Kulkarni S. 2010. Use of model for end-stage liver disease exception points for early liver transplantation and successful reversal of hepatic myelopathy with a review of the literature.Liver Transplant 16(7), 818-826.

Chatauret N, Butterworth RF. 2004. Effects of liver failure on inter-organ trafficking of ammonia: implications for the treatment of hepatic encephalopathy.Journal of Gastroenterology Hepatology 19, 219-223.

Cohen SM, Kim A, Metropulos M, Ahn J. 2011. Legal ramifications for physicians of patients who drive with hepatic encephalopathy.Clinical Gastroenterology Hepatology 9(2), 156-160.

Conn HO, Rössle M, Levy L, Glocker FX. 2006. Portosystemic myelopathy: spastic paraparesis after portosystemic shunting.Scandivina Journal of Gastroenterology 41(5), 619-625.

Cordoba J, Lopez-Hellin J, Planas M. 2004. Normal protein diet for episodic hepatic encephalopathy: results of a randomized study.Journal of Hepatology 41(1), 38-43.

Davis GL, Albright JE, Cook SF, Rosenberg DM. 2003. Projecting future complications of chronic hepatitis C in the United States. Liver Transplant 9(4), 331-338.

Delcker AM, Jalan R, Comes G. 2000. L-ornithine-l-aspartate vs. placebo in the treatment of hepatic encephalopathy: a meta-analysis of randomised placebo-controlled trials using individual data.Hepatology 32, 310.

Donovan JP, Schafer DF, Shaw BW Jr, 1998. Cerebral oedema and increased intracranial pressure in chronic liver disease.Lancet 351(9104), 719-721.

Fanelli F, Salvatori FM, Rabuffi P. 2009. Management of refractory hepatic encephalopathy after insertion of TIPS: long-term results of shunt reduction with hourglass-shaped balloon-expandable stent-graft.AJR American Journal of Roentgenology. 193(6), 1696-1702.

Ferenci P, Lockwood A, Mullen K, Tarter R, Weissenborn K, Blei A. 2002.Hepatic encephalopathy–definition, nomenclature, diagnosis, and quantification: final report of the working party at the 11th World Congresses of Gastroenterology, Vienna, 1998. Hepatology 35(3), 716–721.

Ferenci P. Hepatic encephalopathy. Haubrich WS, Schaffner F, Berk JE. 1995. eds.Bockus Gastroenterology. 5th ed. Philadelphia, Pa: WB Saunders; 1998-2003.

Garcia-Martinez R, Rovira A, Alonso J, Jacas C, Simón-Talero M, Chavarria L. 2011. Hepatic encephalopathy is associated with posttransplant cognitive function and brain volume.Liver Transplant 17(1), 38-46.

Ghabril M, Zupanets IA, Vierling J, Mantry P, Rockey D, Wolf D. 2013. Glycerol phenylbutyrate in patients with cirrhosis and episodic hepatic encephalopathy: a pilot study of safety and effect on venous ammonia concentration.Clinical Pharmacology in Drug Development. 2013. http://dx.doi.org/10.1002/cpdd.18:

Gluud LL, Dam G, Borre M, Les I, Cordoba J, Marchesini G. 2013. Lactulose, rifaximin or branched chain amino acids for hepatic encephalopathy: what is the evidence?Metabolism Brain Diseases 28(2), 221-225.

Groeneweg M, Quero JC, De Bruijn I. 1998. Subclinical hepatic encephalopathy impairs daily functioning. Hepatology 28(1), 45-49.

Guy S, Tanzer-Torres G, Palese M. 1995. Does nasoenteral nutritional support reduce mortality after liver transplant?Hepatology 22, 144.

Hartmann IJC, Groeneweg M, Quero JC. 2000. The prognostic significance of subclinical hepatic encephalopathy. American Journal of Gastroenterology 95(8), 2029-2034.

Kappus MR, Bajaj JS. 2012. Covert hepatic encephalopathy: not as minimal as you might think.Clinical Gastroenterology Hepatology 10(11), 1208-1219.

Kircheis G, Knoche A, Hilger N. 2009. Hepatic encephalopathy and fitness to drive.Gastroenterology 137(5), 1706-1715.

Kircheis G, Nilius R, Held C. 1997. Therapeutic efficacy of L-ornithine-L-aspartate infusions in patients with cirrhosis and hepatic encephalopathy: results of a placebo-controlled, double-blind study.Hepatology 25(6), 1351-1360.

Kok B, Foxton MR, Clough C, Shawcross DL. 2013. Rifaximin is an efficacious treatment for the parkinsonian phenotype of hepatic encephalopathy.Hepatology 7.

Kulisevsky J, Pujol J, Balanzo J. 1992. Pallidal hyperintensity on magnetic resonance imaging in cirrhotic patients: clinical correlations.Hepatology 16(6), 1382-1388.

Malaguarnera M, Pistone G, Elvira R. 2005. Effects of L-carnitine in patients with hepatic encephalopathy. World Journal of Gastroenterology 11(45), 7197-7202.

Marchesini G, Fabbri A, Bianchi G. 1996. Zinc supplementation and amino acid-nitrogen metabolism in patients with advanced cirrhosis.Hepatology 23(5), 1084-1092.

Mas A, Rodes J, Sunyer L. 2003. Comparison of rifaximin and lactitol in the treatment of acute hepatic encephalopathy: results of a randomized, double-blind, double-dummy, controlled clinical trial.Journal of Hepatology 38(1), 51-58.

Miglio F, Valpiani D, Rossellini SR. 1997. Rifaximin, a non-absorbable rifamycin, for the treatment of hepatic encephalopathy. A double-blind, randomised trial.Current Medical Research Opinion 13(10), 593-601.

Mittal VV, Sharma BC, Sharma P, Sarin SK. 2011. A randomized controlled trial comparing lactulose, probiotics, and L-ornithine L-aspartate in treatment of minimal hepatic encephalopathy.European Journal of Gastroenterology Hepatology 23(8), 725-732.

Mullen KD, Dasarathy S. 1999. Hepatic encephalopathy. Schiff ER, Sorrell MF, Maddrey WC, eds.Schiff’s Diseases of the Liver. 8th ed. Philadelphia, Pa: Lippincott-Raven; 545-581.

Mullen KD. 2007. Pathogenesis, clinical manifestation, and diagnosis of hepatic encephalopathy. Seminar Liver Diseases 27(2), 3-9.

Mullen KD. 2006. Review of the final report of the l998 working party on definition, nomenclature and diagnosis of hepatic encephalopathy. Aliment Pharmacology Therigiology 25(1), 11-16.

Munoz SJ. 2007. Driving with minimal hepatic encephalopathy: real world consequences?American Journal of Gastroenterology 102(9), 1910-1911.

Polson J, Lee WM. 2005.AASLD position paper: the management of acute liver failure.Hepatology41, 1179–1197.

Poordad FF. 2007. The burden of hepatic encephalopathy.Alimentry Pharmacology Theriegiology 25, 3-9.

Prasad S, Dhiman RK, Duseja A, Chawla YK, Sharma A, Agarwal R. 2007. Lactulose improves cognitive functions and health-related quality of life in patients with cirrhosis who have minimal hepatic encephalopathy.Hepatology 45(3), 549-559.

Riggio O, Efrati C, Catalano C. 2005. High prevalence of spontaneous portal-systemic shunts in persistent hepatic encephalopathy: a case-control study.Hepatology 42(5), 1158-1165.

Román E, Córdoba J, Torrens M, Torras X, Villanueva C, Vargas V. 2011. Minimal hepatic encephalopathy is associated with falls.American Journal of Gastroenterology 106, 476-482.

Romero-Gómez M, Córdoba J, Jover R. 2007. Value of the critical flicker frequency in patients with minimal hepatic encephalopathy. Hepatology 45(4), 879-885.

Schafer DF, Jones EA. 1982. Hepatic encephalopathy and the gamma-aminobutyric-acid neurotransmitter system. Lancet 1, 18-20.

Sharma BC, Sharma P, Agrawal A, Sarin SK. 2009. Secondary prophylaxis of hepatic encephalopathy: an open-label randomized controlled trial of lactulose versus placebo.Gastroenterology 137(3), 885-891.

Sharma P, Sharma BC, Agrawal A, Sarin SK. 2012. Primary prophylaxis of overt hepatic encephalopathy in patients with cirrhosis: an open labeled randomized controlled trial of lactulose versus no lactulose.Journal of Gastroenterology Hepatoloy 27(8), 1329-1335.

Sidhu SS, Goyal O, Mishra BP, Sood A, Chhina RS, Soni RK. 2011. Rifaximin improves psychometric performance and health-related quality of life in patients with minimal hepatic encephalopathy (the RIME Trial).American Journal of Gastroenterology 106(2), 307-316.

Singhal A, Nagarajan R, Kumar R. 2009. Magnetic resonance T2-relaxometry and 2D L-correlated spectroscopy in patients with minimal hepatic encephalopathy.Journal of Magnetic Reasons Imaging 30(5), 1034-1041.

Sotil EU, Gottstein J, Ayala E, Randolph C, Blei AT. 2009. Impact of preoperative overt hepatic encephalopathy on neurocognitive function after liver transplantation.Liver Transplant 15(2), 184-192.

Spahr L, Coeytaux A, Giostra E. 2007. Histamine H1 blocker hydroxyzine improves sleep in patients with cirrhosis and minimal hepatic encephalopathy: a randomized controlled pilot trial.American Journal of Gastroenterology 102(4), 744-753.

Stahl J. 1963. Studies of the blood ammonia in liver disease. Its diagnostic, prognostic, and therapeutic significance.Annanls of Internal Medicine 58, 1-24.

Stepanova M, Mishra A, Venkatesan C, Younossi ZM. 2012. In-hospital mortality and economic burden associated with hepatic encephalopathy in the United States from 2005 to 2009.Clinical Gastroenterology Hepatology 10(9), 1034-1041.

Stewart CA, Reivich M, Lucey MR. 2005. Neuroimaging in hepatic encephalopathy.Clinical Gastroenterology Hepatology 3(3), 197-207.

Sushma S, Dasarathy S, Tandon RK. 1992. Sodium benzoate in the treatment of acute hepatic encephalopathy: a double-blind randomized trial.Hepatology 16(1), 138-144.

Therrien G, Rose C, Butterworth J. 1997. Protective effect of L-carnitine in ammonia-precipitated encephalopathy in the portacaval shunted rat.Hepatology 25(3), 551-556.

Volk ML, Tocco RS, Bazick J, Rakoski MO, Lok AS. 2012. Hospital readmissions among patients with decompensated cirrhosis.American Journal of Gastroenterology 107(2), 247-252.

Watanabe A, Sakai T, Sato S, Imai F, Ohto M, Arakawa Y. 1997. Clinical efficacy of lactulose in cirrhotic patients with and without subclinical hepatic encephalopathy.Hepatology 26(6), 1410-1414.

Weissenborn K, Ennen JC, Schomerus H, Rückert N, Hecker H. 2001. Neuropsychological characterization of hepatic encephalopathy.Journal of Hepatology 34(5), 768-773.