Prevention of Recurrence of Hepatic Encephalopathy
Overt hepatic encephalopathy (HE) is observed in 30–45% of patients with chronic liver disease and 10–50% of patients with a transjugular intrahepatic portosystemic shunt (TIPS). Minimal hepatic encephalopathy (MHE) affects 20–60% of patients with liver cirrhosis. Recurrence of HE is seen in 47–57% of patients at the end of 1 year. Recurrence of HE is associated with poor prognosis, increased hospitalization, healthcare burden, morbidity, and mortality. Treating patients to prevent development of a first episode of HE is classified as primary prophylaxis and preventing recurrence of HE in patients who had a previous episode of HE as secondary prophylaxis. Available therapy for secondary prophylaxis or prevention of recurrence of HE are nonabsorbable disaccharides like lactulose and lactitol, rifaximin, probiotics, glycerol phenylbutyrate, and branched-chain amino acids. Interventions that decrease portosystemic shunting by embolization of large spontaneous shunts or balloon-occluded retrograde transvenous obliteration of large spontaneous splenorenal shunts are also effective in prevention of recurrence of hepatic encephalopathy.
KeywordsHepatic encephalopathy Lactulose Rifaximin Probiotics Cirrhosis
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