Introduction: current state of knowledge of hepatic encephalopathy (original) (raw)

Pathogenesis, diagnosis, and treatment of hepatic encephalopathy

Journal of clinical and experimental hepatology, 2011

Hepatic encephalopathy (HE) is a neuropsychiatric disorder seen in patients with advanced liver disease or porto-systemic shunts. Based on etiology and severity of HE, the World Congress of Gastroenterology has divided HE into categories and sub-categories. Many user-friendly computer-based neuropsychiatric tests are being validated for diagnosing covert HE. Currently, emphasis is being given to view HE deficits as a continuous spectrum rather than distinct stages. Ammonia is believed to play crucial role in pathogenesis of HE via astrocyte swelling and cerebral edema. However, evidence has been building up which supports the synergistic role of oxidative stress, inflammation and neurosteroids in pathogenesis of HE. At present, treatment of HE aims at decreasing the production and intestinal absorption of ammonia. But as the role of new pathogenetic mechanisms becomes clear, many potential new treatment strategies may become available for clinician.

Hepatic Encephalopathy: Diagnosis and Current Therapies

2015

Hepatic encephalopathy (HE) is a neuropsychological, and a serious neurotoxic disease. HE varies in clinical presentation, in pathogenesis and treatment. HE is caused by the accumulation in the bloodstream of toxic substances that are normally removed by the liver.Clinical manifestations of HE include a wide spectrum of neuropsychiatric and neurological symptoms, disorientation and poor coordination. Acute HE is associated with severe liver failure in patients with fulminant hepatic failure. In chronic HE have neuropsychiatric syndrome characterized with depression of the central nervous system, with varying degrees of severity. HE is traditionally graded into four clinical stages. The synergistic effects of excess ammonia and inflammation cause astrocyte swelling and cerebral edema. Diagnosis of HE include neuropsychometric tests, brain imaging and clinical scales, the West Haven Criteria. Treatment is based on reducing the production and absorption of ammonia, with anti-microbial ...

Current Management of Hepatic Encephalopathy: A Review Article

Journal for Research in Applied Sciences and Biotechnology

Hepatic encephalopathy, a neuropsychiatric syndrome stemming from liver failure, manifests in acute and chronic cases. The prevailing cause behind its development involves the neurotoxicity resulting from elevated ammonia levels in the brain, which can occur due to increased ammonia production or impaired ammonia excretion. The main objective in treating hepatic encephalopathy is to decrease ammonia levels. The detoxification of ammonia in this condition is regulated by two enzymes: glutaminase and glutamine synthetase. Numerous drugs, such as lactulose, rifaximin, BCAA, LOLA, glycerol phenylbutyrate, and zinc, have been utilized to treat hepatic encephalopathy. In terms of future research, experimental treatment options like fecal microbiota transplant, probiotics, bromocriptine, minocycline, indomethacin, ibuprofen, and flumazenil warrant investigation. Furthermore, albumin infusions have been shown to enhance cognitive function and improve the psychosocial quality of life, possib...

Update on the Therapeutic Management of Hepatic Encephalopathy

Current gastroenterology reports, 2018

Hepatic encephalopathy (HE) is a common and devastating complication to chronic liver disease. In this paper, we summarize the latest research and evidence of both conventional and up-coming treatments. Meta-analyses report beneficial effects of lactulose, branched-chain amino acids, rifaximin, and to some degree L-ornithine L-aspartate on the manifestations of HE in patients with cirrhosis, and generally the numbers needed to treat are low. Recent studies on newer HE treatments including ornithine phenylacetate, spherical carbon, and fecal microbiota transplant also report potentially beneficial effects on HE manifestations. The conventional treatments benefit patients with HE. Newer treatments are under study and more research is needed for their validation.