Future Therapies of Hepatic Encephalopathy
Hepatic encephalopathy, either covert or overt, affects more than half of patients with cirrhosis and has lasting effects even after portal hypertension is corrected. Unfortunately, the current therapeutic options still result in high rates of relapse and progression, in part owing to cost barriers and side effects, leading to poor adherence. This review summarizes emerging treatment options, which could take advantage of alternative disease pathways to improve future care of those with hepatic encephalopathy. (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - March 27, 2024 Category: Gastroenterology Authors: Adam P. Buckholz, Robert S. Brown Source Type: research
Hepatic Encephalopathy
CLINICS IN LIVER DISEASE (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - March 27, 2024 Category: Gastroenterology Authors: Sammy Saab Source Type: research
Copyright
Elsevier (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - March 27, 2024 Category: Gastroenterology Source Type: research
Contributors
NORMAN GITLIN, MD, FRCP (London), FRCPE (Edinburgh), FAASLD, FACP, FACG (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - March 27, 2024 Category: Gastroenterology Source Type: research
Contents
Sammy Saab (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - March 27, 2024 Category: Gastroenterology Source Type: research
Forthcoming Issues
Portal Hypertension and Its Complications (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - March 27, 2024 Category: Gastroenterology Source Type: research
Pathophysiology of Hepatic Encephalopathy
Hepatic encephalopathy (HE) is a neuropsychiatric syndrome that is observed primarily in patients with liver disease. The pathophysiology is complex and involves many factors including ammonia toxicity, dysregulation of central nervous system activity, and excess inflammatory cytokines. Symptoms of HE range from subclinical to debilitating. HE can be difficult to treat and represents a large burden to patients, their caregivers, and the health-care system because of associated resource utilization. This review article provides an overview of the current understanding of the pathophysiology behind HE and where the current r...
Source: Clinics in Liver Disease - February 20, 2024 Category: Gastroenterology Authors: Alexander Chen, Christopher Tait, Carlos Minacapelli, Vinod Rustgi Source Type: research
Hepatic Encephalopathy
Hepatic encephalopathy (HE) is an extremely debilitating complication of liver cirrhosis. The basis for the development of HE stems from the interaction of dysbiosis, sarcopenia, liver insufficiency, and portal hypertension.1 Precipitants of HE include electrolyte disturbances, renal insufficiency, constipation, infection, gastrointestinal bleeding, and use of select medications. Hepatic encephalopathy is rather unique among other manifestations of liver failure in that it affects not only patients but also their caregivers; leaves a cognitive footprint that can persist even after liver transplantation; is a hallmark that ...
Source: Clinics in Liver Disease - February 19, 2024 Category: Gastroenterology Authors: Sammy Saab Tags: Preface Source Type: research
Nontraditional Treatment of Hepatic Encephalopathy
The pathophysiology of hepatic encephalopathy (HE) is complex, with hyperammonemia playing a central role in its development. Traditional therapies for HE have targeted ammonia and include medications such as lactulose and rifaximin. Although these agents are considered standard of care, nontraditional treatments seek to affect other factors in the pathogenesis of HE. Finally, procedural therapies include albumin dialysis, shunt closure, and the ultimate cure for HE, which is liver transplant. The treatments discussed provide alternative options for patients who have failed standard of care. However, more high-quality stud...
Source: Clinics in Liver Disease - February 15, 2024 Category: Gastroenterology Authors: Jasleen Singh, Brittney Ibrahim, Steven-Huy Han Source Type: research
The Health Care Burden of Hepatic Encephalopathy
Hepatic encephalopathy —a common and debilitating complication of cirrhosis—results in major health care burden on both patients and caregivers through direct and indirect costs. In addition to risk of falls, inability to work and drive, patients with hepatic encephalopathy often require hospital admission (and often readmission), and many require subacute care following hospitalization. The costs and psychological impact of liver transplantation often ensue. As the prevalence of chronic liver disease increases throughout the United States, the health care burden of hepatic encephalopathy will continue to grow. (Source...
Source: Clinics in Liver Disease - February 12, 2024 Category: Gastroenterology Authors: Kevin B. Harris, Humberto C. Gonzalez, Stuart C. Gordon Source Type: research
Preventing Readmissions of Hepatic Encephalopathy
Hepatic encephalopathy (HE) is a strong predictor of early hospital readmission in patients with cirrhosis. Early hospital readmission increases health care costs and is associated with worse survival. Herein we provide an overview of strategies to prevent hospital readmissions in patients with HE, divided into 3 contexts: (a) acute inpatient, (b) immediate postdischarge, and (c) longitudinal outpatient setting. (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - February 12, 2024 Category: Gastroenterology Authors: Emily Lin, Devika Gandhi, Michael Volk Source Type: research
Social Impact of Hepatic Encephalopathy
Hepatic encephalopathy is a medical condition that stems from liver dysfunction, leading to the accumulation of toxins in the bloodstream. This can result in cognitive impairments, mood changes, and motor dysfunction. Its social impact includes challenges in employment, relationships, and daily functioning for affected individuals. Stigma and misunderstanding around the condition can further exacerbate the difficulties faced by both patients and their caregivers. Efforts to raise awareness, improve medical management, and provide support systems can help mitigate the social impact of hepatic encephalopathy. (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - February 12, 2024 Category: Gastroenterology Authors: Akshay Shetty, Elena G. Saab, Gina Choi Source Type: research
Interventional Radiology Management of Hepatic Encephalopathy
Hepatic encephalopathy (HE) is a clinically severe and devastating complication of decompensated liver disease affecting mortality, quality of life for patients and families, hospital admission rates, and overall health-care costs globally. Depending on the cause of HE, several medical treatment options have been developed and become available. In some refractory HE, such as spontaneous portosystemic shunt-related HE (SPSS-HE) or posttransjugular intrahepatic portosystemic shunt HE (post-TIPS HE), advanced interventional radiology (IR) procedures have been used, and shown to be effective in these conditions. This review pr...
Source: Clinics in Liver Disease - February 10, 2024 Category: Gastroenterology Authors: Edward Wolfgang Lee, Justine J. Liang, Griffin P. McNamara Source Type: research
Minimal Hepatic Encephalopathy
Minimal hepatic encephalopathy (MHE) is a pervasive frequent complication of cirrhosis of any etiology. The diagnosis of MHE is difficult as the standard neurologic examination is essentially within normal limits. None of the symptoms and signs of overt HE is present in a patient with MHE, such as confusion, disorientation, or asterixis. Progress has been made in diagnostic tools for detection of attention and cognitive deficits at the point of care of MHE. The development of MHE significantly impacts quality of life and activities of daily life in affected patients including driving motor vehicles and machine operation. (...
Source: Clinics in Liver Disease - February 8, 2024 Category: Gastroenterology Authors: Rachel Redfield, Nyan Latt, Santiago J. Munoz Source Type: research
Hepatic Encephalopathy
Hepatic encephalopathy (HE) can occur as a complication of chronic liver disease as well as acute liver failure. HE is associated with significantly increased morbidity and worse patient outcomes. The clinical manifestation of HE ranges from early less-severe presentations that may only be accurately detected on dedicated psychomotor diagnostic testing to overt alterations in cognition and mental status to the most severe form of coma. Greater awareness of the clinical manifestations of HE across the spectrum of symptom severity is critical for early identification and timely initiation of appropriate therapy to improve pa...
Source: Clinics in Liver Disease - February 2, 2024 Category: Gastroenterology Authors: Kabiru Ohikere, Robert J. Wong Source Type: research
