Hepatic encephalopathy: issues relevant to clinical practice

Abstract

Hepatic encephalopathy (HE) remains one of\xa0the\xa0most serious complications of\xa0liver cirrhosis. Its clinical spectrum sometimes creates difficulties in\xa0the\xa0optimal diagnosis at the\xa0patient’s bedside and treatment. To present new data\xa0on the\xa0field of\xa0clinical management of\xa0cirrhotic patients with hepatic encephalopathy. The\xa0role of\xa0ammonia\xa0in\xa0the\xa0diagnosis of\xa0HE is still under discussion. In\xa0clinical practice, in\xa0patients with suspected overt HE, normal ammonia\xa0concentration can be used to exclude this diagnosis. In\xa0contrast, a\xa0high concentration of\xa0ammonia\xa0in\xa0the\xa0absence of\xa0clinical signs of\xa0HE should not serve as a\xa0criterion for\xa0this diagnosis and as a\xa0guide for\xa0treatment. A\xa0separate issue for\xa0discussion is the\xa0covert HE. The\xa0simplest and most affordable test for\xa0screening for\xa0covert HE and evaluating the\xa0effectiveness of\xa0therapy is the\xa0animal naming test, which can be done on bedside by physician or caregivers. Patients with covert HE need treatment that is similar in\xa0approach to overt HE. The\xa0diagnosis of\xa0overt HE and the\xa0methods of\xa0its therapy are well known. According to Russian recommendations, depending on the\xa0disease course in\xa0a\xa0certain\xa0patient, lactulose, rifaximin, L-ornithine L-aspartate can be used as first-line drugs, which is applicable to the\xa0treatment of\xa0both overt and latent PE. The\xa0main\xa0issues on the\xa0management of\xa0HE in\xa0liver cirrhosis relate to the\xa0diagnostic role of\xa0ammonia, optimal diagnosis and treatment strategy for\xa0covert HE, therapy of\xa0choice for\xa0both overt and latent HE. There are expert opinions and consensus documents on all these issues. Treatment of\xa0overt and latent PE is carried out according to the\xa0same principles. Drugs of\xa0choice: lactulose, rifaximin\xa0and L-Ornithine L-Aspartate.