Hepatic encephalopathy 2018: A clinical practice guideline by the Italian Association for the Study of the Liver (AISF)

Sara Montagnese; Francesco Paolo Russo; Piero Amodio; Patrizia Burra; Antonio Gasbarrini; Carmela Loguercio; Giulio Marchesini; Manuela Merli; Francesca Romana Ponziani; Oliviero Riggio; Carmelo Scarpignato

doi:10.1016/j.dld.2018.11.035

Hepatic encephalopathy 2018: A clinical practice guideline by the Italian Association for the Study of the Liver (AISF)

Dig Liver Dis. 2019 Feb;51(2):190-205. doi: 10.1016/j.dld.2018.11.035. Epub 2018 Dec 12.

Affiliations

¹ Department of Medicine, University of Padova, Italy. Electronic address: sara.montagnese@unipd.it.
² Department of Surgery, Oncology and Gastroenterology, University of Padova, Italy.
³ Department of Medicine, University of Padova, Italy.
⁴ Division of Internal Medicine, Gastroenterology and Hepatology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy.
⁵ Department of Clinical and Experimental Medicine, University of Campania "L. Vanvitelli", Naples, Italy.
⁶ Unit of Metabolic Diseases & Clinical Dietetics, Department of Medical and Surgical Sciences, University of Bologna, Italy.
⁷ Division of Gastroenterology, Department of Clinical Medicine, La Sapienza University of Rome, Italy.
⁸ Clinical Pharmacology & Digestive Pathophysiology Unit, Department of Clinical & Experimental Medicine, University of Parma, Italy.

PMID: 30606696
DOI: 10.1016/j.dld.2018.11.035

Abstract

Hepatic encephalopathy (HE) is a common, worrisome and sometimes difficult to manage complication of end-stage liver disease. HE is often recurrent, requiring multiple hospital admissions. It can have serious implications in terms of a patient's ability to perform complex tasks (for example driving), their earning capacity, their social and family roles. This guideline reviews current knowledge on HE definition, pathophysiology, diagnosis and treatment, both by general principles and by way of a summary of available drugs and treatment strategies. The quality of the published, pertinent evidence is graded, and practical recommendations are made. Where possible, these are placed within the Italian health service context, with reference to local diagnosis and management experience.

Keywords: AISF; Guideline; Hepatic encephalopathy.

Publication types

Practice Guideline

MeSH terms

End Stage Liver Disease / complications*
Hepatic Encephalopathy* / diagnosis
Hepatic Encephalopathy* / etiology
Hepatic Encephalopathy* / therapy
Humans
Italy
Patient Care Management* / methods
Patient Care Management* / organization & administration