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Sharma P, Sharma BC. Management of overt hepatic encephalopathy. J Clin Exp Hepatol. 2014;5:S82-7doi: 10.1016/j.jceh.2014.04.004.
Sharma, P., & Sharma, B. C. (2015). Management of overt hepatic encephalopathy. Journal of clinical and experimental hepatology, 5S82-7. https://doi.org/10.1016/j.jceh.2014.04.004
Sharma, Praveen, and Sharma, Barjesh C. "Management of overt hepatic encephalopathy." Journal of clinical and experimental hepatology vol. 5 (2015): S82-7. doi: https://doi.org/10.1016/j.jceh.2014.04.004
Sharma P, Sharma BC. Management of overt hepatic encephalopathy. J Clin Exp Hepatol. 2015 Mar;5:S82-7. doi: 10.1016/j.jceh.2014.04.004. Epub 2014 May 10. PMID: 26041964; PMCID: PMC4442855.
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J Clin Exp Hepatol. 2015 Mar;5:S82-7. doi: 10.1016/j.jceh.2014.04.004. Epub 2014 May 10.

Management of overt hepatic encephalopathy.

Journal of clinical and experimental hepatology

Praveen Sharma, Barjesh C Sharma

Affiliations

  1. Department of Gastroenterology, Sir Ganga Ram Hospital, New Delhi, India.
  2. Department of Gastroenterology, G.B. Pant Hospital, New Delhi, India.

PMID: 26041964 PMCID: PMC4442855 DOI: 10.1016/j.jceh.2014.04.004

Abstract

Hepatic encephalopathy (HE) is an important complication of cirrhosis with significant morbidity and mortality. Management of HE primarily involves avoidance of precipitating factors and administration of various ammonia-lowering therapies such as non-absorbable disaccharides, antimicrobial agents like rifaximin and l-ornithine l-aspartate. The non-absorbable disaccharides which include lactulose and lactitol are considered the first-line therapy for the treatment of HE and in primary and secondary prophylaxis of HE. Lactitol is comparable to lactulose in the treatment of HE with fewer side effects. Rifaximin is effective in treatment of HE and recent systemic reviews found it comparable to disaccharides and is effective in secondary prophylaxis of HE. Many agents like l-ornithine l-aspartate, probiotics, zinc, sodium benzoate have been tried either alone or in combination with lactulose for the treatment of HE. Combination therapy of disaccharides either with rifaximin, l-ornithine l-aspartate, probiotics for the treatment of HE needs further validation in large studies.

Keywords: HE, hepatic encephalopathy; HR, hazard ratio; MHE, minimal hepatic encephalopathy; TIPS, transjugular intrahepatic portosystemic shunt; disaccharides; hepatic encephalopathy; lactulose

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