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Prevention of Recurrence of Hepatic Encephalopathy

  • Sudhir Maharshi
  • Barjesh Chander Sharma
Chapter

Abstract

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.

Keywords

Hepatic encephalopathy Lactulose Rifaximin Probiotics Cirrhosis 

References

  1. 1.
    Poordad FF. The burden of hepatic encephalopathy. Aliment Pharmacol Ther. 2007;25(suppl 1):3–9.CrossRefPubMedGoogle Scholar
  2. 2.
    Stewart CA, Malinchoc M, Kim WR, Kamath PS. Hepatic encephalopathy as a predictor of survival in patients with end stage liver disease. Liver Transpl. 2007;13:1366–71.CrossRefPubMedGoogle Scholar
  3. 3.
    Ferenci P, Lockwood A, Mullen K, Tarter R, Weissenborn K, Blei AT. Hepatic encephalopathy—definition, nomenclature, diagnosis and quantification: final report of the working party at the 11th World Congress of Gastroenterology, Vienna, 1998. Hepatology. 2002;35:716–21.CrossRefPubMedGoogle Scholar
  4. 4.
    Sharma BC, Sharma P, Agrawal A, Sarin SK. Secondary prophylaxis of hepatic encephalopathy: an open-label randomized controlled trial of lactulose versus placebo. Gastroenterology. 2009;137:885–91.CrossRefPubMedGoogle Scholar
  5. 5.
    Bass NM, Mullen KD, Sanyal A, Poordad F, Neff G, Leevy CB, et al. Rifaximin treatment in hepatic encephalopathy. N Engl J Med. 2010;362:1071–81.CrossRefGoogle Scholar
  6. 6.
    Agrawal A, Sharma BC, Sharma P, Sarin SK. Secondary prophylaxis of hepatic encephalopathy in cirrhosis: an open-label, randomized controlled trial of lactulose, probiotics, and no therapy. Am J Gastroenterol. 2012;107(7):1043–50.CrossRefPubMedGoogle Scholar
  7. 7.
    Sharma BC, Maharshi S. Prevention of hepatic encephalopathy recurrence. Clin Liver Dis. 2015;5(3):64–7.CrossRefGoogle Scholar
  8. 8.
    Rocky DC, Vierling JM, Mantry P, Ghabril M, Brown RS, Alexeeva O, et al. Randomized, double-blind, controlled study of glycerol, phenylbutyrate in hepatic encephalopathy. Hepatology. 2014;59:1073–83.CrossRefGoogle Scholar
  9. 9.
    Les L, Doval E, Martinez RG, Planas M, Cárdenas G, Gómez P, et al. Effects of branched-chain amino acids supplementation in patients with cirrhosis and a previous episode of hepatic encephalopathy: a randomized study. Am J Gastroenterol. 2011;106:1081–8.CrossRefPubMedGoogle Scholar
  10. 10.
    Laleman W, Talero SM, Maleux G, Perez M, Ameloot K, Soriano G, et al. Embolization of large spontaneous portosystemic shunts for refractory hepatic encephalopathy: a multicenter survey on safety and efficacy. Hepatology. 2013;57:2448–57.CrossRefPubMedGoogle Scholar
  11. 11.
    Mukund A, Rajesh S, Arora A, Patidar Y, Jain D, Sarin SK. Efficacy of balloon-occluded retrograde transvenous obliteration of large spontaneous lienorenal shunt in patients with severe recurrent hepatic encephalopathy with foam sclerotherapy: initial experience. J Vasc Interv Radiol. 2012;23:1200–6.CrossRefPubMedGoogle Scholar
  12. 12.
    Neff G. Factors affecting compliance and persistence with treatment for hepatic encephalopathy. Pharmacotherapy. 2010;30:22S–7S.CrossRefPubMedGoogle Scholar
  13. 13.
    Leevy CB, Phillips JA. Hospitalizations during the use of rifaximin versus lactulose for the treatment of hepatic encephalopathy. Dig Dis Sci. 2007;52:737–41.CrossRefPubMedGoogle Scholar
  14. 14.
    Sanyal A, Younossi ZM, Bass NM, Mullen KD, Poordad F, Brown RS, et al. Randomised clinical trial: rifaximin improves health-related quality of life in cirrhotic patients with hepatic encephalopathy—a double-blind placebo controlled study. Aliment Pharmacol Ther. 2011;34:853–61.CrossRefPubMedGoogle Scholar
  15. 15.
    Mullen KD, Sanyal AJ, Bass NM, Poordad F, Sheikh MY, Frederick RT, et al. Rifaximin is safe and well tolerated for long-term maintenance remission from overt hepatic encephalopathy. Clin Gastroenterol Hepatol. 2014;12(8):1390–7.CrossRefPubMedGoogle Scholar
  16. 16.
    Lyon KC, Likar E, Martello JL, Regier M. Retrospective cross-sectional pilot study of rifaximin dosing for the prevention of recurrent hepatic encephalopathy. J Gastroenterol Hepatol. 2017.  https://doi.org/10.1111/jgh.13759.
  17. 17.
    Riggio O, Masini A, Efrati C, Nicolao F, Angeloni S, Salvatori FM, et al. Pharmacological prophylaxis of hepatic encephalopathy after transjugular intrahepatic portosystemic shunt: a randomized controlled study. J Hepatol. 2005;42(5):674–9.CrossRefPubMedGoogle Scholar
  18. 18.
    Lata J, Jurankova J, Kopakova M, Vitek P. Probiotics inn hepatology. World J Gastroenterol. 2011;17:2890–6.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Lunia MK, Sharma BC, Sharma P, Sachdeva S, Srivastava S. Probiotics prevent hepatic encephalopathyin patients with cirrhosis: a randomized controlled trial. Clin Gastroenterol Hepatol. 2014;12(6):1003–8.CrossRefPubMedGoogle Scholar
  20. 20.
    Dhiman RK, Rana B, Agrawal S, Garg A, Chopra M, Thumburu KK, et al. Probiotic VSL#3 reduces liver disease severity and hospitalization in patients with cirrhosis: a randomized, controlled trial. Gastroenterology. 2014;147(6):1327–37.CrossRefPubMedGoogle Scholar
  21. 21.
    Singh S, Kamath PS, Andrews JC, Leise MD. Embolization of spontaneous portosystemic shunts for management of severe persistent hepatic encephalopathy. Hepatology. 2014;59(2):735–6.CrossRefPubMedGoogle Scholar
  22. 22.
    Leise MD, Poterucha JJ, Kamath PS, Kim WR. Management of hepatic encephalopathy in the hospiatal. Mayo Clin Proc. 2014;89(2):241–53.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Bajaj JS, Kassam Z, Fagan A, Gavis EA, Lin E, Cox IJ, et al. Fecal microbiota transplant from a rational stool donor improves hepatic encephalopathy: a randomized clinical trial. Hepatology. 2017;66(6):1727–38.CrossRefPubMedGoogle Scholar
  24. 24.
    Wang WW, Zhang Y, Huang XB, You N, Zheng L, Jing L. Fecal microbiota transplantation prevents hepatic encephalopathy in rats with carbon tetrachloride-induced acute hepatic dysfunction. World J Gastroenterol. 2017;23(38):6983–94.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Sudhir Maharshi
    • 1
  • Barjesh Chander Sharma
    • 2
  1. 1.Department of GastroenterologySMS Medical CollegeJaipurIndia
  2. 2.Department of GastroenterologyG.B. Pant HospitalNew DelhiIndia

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