Covert and Overt Hepatic Encephalopathy: Diagnosis and Management

被引:154
作者
Patidar, Kavish R.
Bajaj, Jasmohan S. [1 ,2 ]
机构
[1] Virginia Commonwealth Univ, Div Gastroenterol Hepatol & Nutr, Richmond, VA 23284 USA
[2] McGuire VA Med Ctr, Richmond, VA USA
关键词
Cirrhosis; Covert Hepatic Encephalopathy; Overt Hepatic Encephalopathy; Hepatic Encephalopathy; Ammonia; Lactulose; Rifaximin; ORNITHINE-L-ASPARTATE; RANDOMIZED CONTROLLED-TRIAL; PORTAL-SYSTEMIC ENCEPHALOPATHY; CRITICAL FLICKER FREQUENCY; CHRONIC LIVER-DISEASE; QUALITY-OF-LIFE; DOUBLE-BLIND; OPEN-LABEL; CIRRHOTIC-PATIENTS; CLINICAL-TRIAL;
D O I
10.1016/j.cgh.2015.06.039
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Hepatic encephalopathy (HE) is part of a spectrum of neurocognitive changes in cirrhosis. HE is divided into 2 broad categories based on severity: covert hepatic encephalopathy (CHE) and overt hepatic encephalopathy (OHE). CHE has a significant impact on a patient's quality of life, driving performance, and recently has been associated with increased hospitalizations and death. Likewise, OHE is associated with increased rates of hospitalizations and mortality, and poor quality of life. Given its significant burden on patients, care takers, and the health care system, early diagnosis and management are imperative. In addition, focus also should be directed on patient and family member education on the disease progression and adherence to medications. Treatment strategies include the use of nonabsorbable disaccharides, antibiotics (ie, rifaximin), and, potentially, probiotics. Other therapies currently under further investigation include L-ornithine-L-aspartate, ornithine phenylacetate, glycerol phenylbutyrate, molecular adsorbent recirculating system, and albumin infusion.
引用
收藏
页码:2048 / 2061
页数:14
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