Emergent Management of Hepatic Encephalopathy: An Updated Review

Abstract

Background: Hepatic encephalopathy (HE) is a neuropsychiatric disorder associated with liver dysfunction. It presents as overt or minimal HE and significantly impacts prognosis, particularly in cirrhosis and acute liver failure. Despite advancements, HE remains a clinical challenge due to its heterogeneity and the complexities in diagnosis and management.

Aim: To review and summarize the emergent strategies for diagnosing and managing HE, including clinical, pharmacological, and innovative therapeutic approaches.

Methods: A comprehensive analysis of current literature was conducted, emphasizing standardized classification systems, diagnostic modalities, and management protocols. Key areas include addressing precipitating factors, employing pharmacological treatments, and exploring emerging therapies like fecal microbiota transplantation (FMT).

Results: Standardized criteria, including the West Haven classification, aid in grading HE severity. Clinical and neuropsychological assessments remain pivotal, complemented by imaging and laboratory tests. Effective management involves treating precipitating factors such as infections, gastrointestinal bleeding, and electrolyte imbalances. Pharmacological options include lactulose, rifaximin, and l-ornithine l-aspartate, which target ammonia detoxification. Emerging therapies like FMT show promise in improving cognitive outcomes by restoring gut microbiota diversity. Liver transplantation remains critical for long-term survival in advanced cases.

Conclusion: HE management necessitates a multidisciplinary approach, integrating established and innovative interventions. Addressing precipitating factors, optimizing pharmacological regimens, and exploring novel therapies are essential for improving outcomes. Future research should validate emerging therapies to integrate them into clinical practice effectively.