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Treatment Options for Covert Hepatic Encephalopathy

  • Sahaj Rathi
  • Radha K. Dhiman
Chapter

Abstract

Hepatic encephalopathy, even in its mildest form, can lead to significant deterioration in quality of life, lower overall survival, and add to caregiver burden. However, due to a paucity of symptoms, covert hepatic encephalopathy (CHE) is often ignored or neglected by physicians as well as patients. The lack of consensus among experts for both diagnosis as well as treatment of CHE adds to this problem. Treatment options for CHE include lactulose, rifaximin, ammonia scavengers, branched-chain amino acids, and probiotics. In this chapter we review the existing evidence on these agents and explain treatment decisions using a case-based approach.

Keywords

Covert hepatic encephalopathy Portosystemic shunt Psychometric hepatic encephalopathy score Minimal hepatic encephalopathy 

Abbreviations

AASLD

American Association for the Study of Liver Diseases

BCAA

Branched-chain amino acids

CFF

Critical flicker frequency

CHE

Covert hepatic encephalopathy

EASL

European Association for the Study of the Liver

HE

Hepatic encephalopathy

LOLA

l-Ornithine l-aspartate

MELD

Model for end-stage liver disease

MMSE

Mini-mental state examination

OHE

Overt hepatic encephalopathy

PHES

Psychometric hepatic encephalopathy score

PSS

Portosystemic shunt

SBP

Spontaneous bacterial peritonitis

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Sahaj Rathi
    • 1
  • Radha K. Dhiman
    • 1
  1. 1.Department of HepatologyPost Graduate Institute of Medical Education and ResearchChandigarhIndia

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