Current Management of Hepatic Encephalopathy

Hepatic encephalopathy (HE) is a complication of liver dysfunction and portosystemic shunting. The purpose of this review is to discuss the management of HE.

Traditional therapies include lactulose and rifaximin, but other treatment options have recently emerged. Branched chain amino acids are involved in the Krebs cycle and have an inverse relationship with ammonia. Flumazenil, a benzodiazepine antagonist, has a negative effect on the gamma-aminobutyric acid receptor, which plays a role in cognitive deficits. Because of microbiome changes, fecal microbiota transplantation and probiotics are emerging therapeutic considerations.

Despite multiple therapies for HE, the emerging options have shown varying degrees of evidence. Future studies are needed to examine the impact of each therapy on the different grades of HE, as most studies showed benefit for primarily lower grades. Future studies should also investigate whether certain therapeutic combinations are favored.