Hepatic encephalopathy: current challenges and future prospects

Mirashini Swaminathan,1 Mark Alexander Ellul,2 Timothy JS Cross1 1Department of Gastroenterology, Royal Liverpool University Hospital, 2Faculty of Health and Life Sciences, Institute of Infection and Global Health, University of Liverpool, Liverpool, UK Abstract: Hepatic encephalopathy (HE) is a com...

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Autores principales:	Swaminathan M, Ellul MA, Cross TJS
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2018
Materias:	Hepatic encephalopathy pathogenesis treatment lactulose rifaximin probiotics Diseases of the digestive system. Gastroenterology RC799-869
Acceso en línea:	https://doaj.org/article/1bef8b2c810a4789a5abfc82e0e66767
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spelling	oai:doaj.org-article:1bef8b2c810a4789a5abfc82e0e667672021-12-02T07:28:05ZHepatic encephalopathy: current challenges and future prospects1179-1535https://doaj.org/article/1bef8b2c810a4789a5abfc82e0e667672018-03-01T00:00:00Zhttps://www.dovepress.com/hepatic-encephalopathy-current-challenges-and-future-prospects-peer-reviewed-article-HMERhttps://doaj.org/toc/1179-1535Mirashini Swaminathan,1 Mark Alexander Ellul,2 Timothy JS Cross1 1Department of Gastroenterology, Royal Liverpool University Hospital, 2Faculty of Health and Life Sciences, Institute of Infection and Global Health, University of Liverpool, Liverpool, UK Abstract: Hepatic encephalopathy (HE) is a common complication of liver dysfunction, including acute liver failure and liver cirrhosis. HE presents as a spectrum of neuropsychiatric symptoms ranging from subtle fluctuating cognitive impairment to coma. It is a significant contributor of morbidity in patients with liver disease. HE is observed in acute liver failure, liver bypass procedures, for example, shunt surgery and transjugular intrahepatic portosystemic shunt, and cirrhosis. These are classified as Type A, B and C HE, respectively. HE can also be classified according to whether its presence is overt or covert. The pathogenesis is linked with ammonia and glutamine production, and treatment is based on mechanisms to reduce the formation and/or removal of these compounds. There is no specific diagnostic test for HE, and diagnosis is based on clinical suspicion, excluding other causes and use of clinical tests that may support its diagnosis. Many tests are used in trials and experimentally, but have not yet gained universal acceptance. This review focuses on the definitions, pathogenesis and treatment of HE. Consideration will be given to existing treatment, including avoidance of precipitating factors and novel therapies such as prebiotics, probiotics, antibiotics, laxatives, branched-chain amino acids, shunt embolization and the importance of considering liver transplant in appropriate cases. Keywords: hepatic encephalopathy, pathogenesis, treatment, lactulose, rifaximin, probiotics, covert hepatic encephalopathySwaminathan MEllul MACross TJSDove Medical PressarticleHepatic encephalopathypathogenesistreatmentlactuloserifaximinprobioticsDiseases of the digestive system. GastroenterologyRC799-869ENHepatic Medicine: Evidence and Research, Vol Volume 10, Pp 1-11 (2018)
institution	DOAJ
collection	DOAJ
language	EN
topic	Hepatic encephalopathy pathogenesis treatment lactulose rifaximin probiotics Diseases of the digestive system. Gastroenterology RC799-869
spellingShingle	Hepatic encephalopathy pathogenesis treatment lactulose rifaximin probiotics Diseases of the digestive system. Gastroenterology RC799-869 Swaminathan M Ellul MA Cross TJS Hepatic encephalopathy: current challenges and future prospects
description	Mirashini Swaminathan,1 Mark Alexander Ellul,2 Timothy JS Cross1 1Department of Gastroenterology, Royal Liverpool University Hospital, 2Faculty of Health and Life Sciences, Institute of Infection and Global Health, University of Liverpool, Liverpool, UK Abstract: Hepatic encephalopathy (HE) is a common complication of liver dysfunction, including acute liver failure and liver cirrhosis. HE presents as a spectrum of neuropsychiatric symptoms ranging from subtle fluctuating cognitive impairment to coma. It is a significant contributor of morbidity in patients with liver disease. HE is observed in acute liver failure, liver bypass procedures, for example, shunt surgery and transjugular intrahepatic portosystemic shunt, and cirrhosis. These are classified as Type A, B and C HE, respectively. HE can also be classified according to whether its presence is overt or covert. The pathogenesis is linked with ammonia and glutamine production, and treatment is based on mechanisms to reduce the formation and/or removal of these compounds. There is no specific diagnostic test for HE, and diagnosis is based on clinical suspicion, excluding other causes and use of clinical tests that may support its diagnosis. Many tests are used in trials and experimentally, but have not yet gained universal acceptance. This review focuses on the definitions, pathogenesis and treatment of HE. Consideration will be given to existing treatment, including avoidance of precipitating factors and novel therapies such as prebiotics, probiotics, antibiotics, laxatives, branched-chain amino acids, shunt embolization and the importance of considering liver transplant in appropriate cases. Keywords: hepatic encephalopathy, pathogenesis, treatment, lactulose, rifaximin, probiotics, covert hepatic encephalopathy
format	article
author	Swaminathan M Ellul MA Cross TJS
author_facet	Swaminathan M Ellul MA Cross TJS
author_sort	Swaminathan M
title	Hepatic encephalopathy: current challenges and future prospects
title_short	Hepatic encephalopathy: current challenges and future prospects
title_full	Hepatic encephalopathy: current challenges and future prospects
title_fullStr	Hepatic encephalopathy: current challenges and future prospects
title_full_unstemmed	Hepatic encephalopathy: current challenges and future prospects
title_sort	hepatic encephalopathy: current challenges and future prospects
publisher	Dove Medical Press
publishDate	2018
url	https://doaj.org/article/1bef8b2c810a4789a5abfc82e0e66767
work_keys_str_mv	AT swaminathanm hepaticencephalopathycurrentchallengesandfutureprospects AT ellulma hepaticencephalopathycurrentchallengesandfutureprospects AT crosstjs hepaticencephalopathycurrentchallengesandfutureprospects
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Hepatic encephalopathy: current challenges and future prospects

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