Diagnosis and Management of Hepatic Encephalopathy

Marika Rudler; Nicolas Weiss; Charlotte Bouzbib; Dominique Thabut

doi:10.1016/j.cld.2021.01.008

Diagnosis and Management of Hepatic Encephalopathy

Clin Liver Dis. 2021 May;25(2):393-417. doi: 10.1016/j.cld.2021.01.008. Epub 2021 Mar 11.

Authors

Marika Rudler¹, Nicolas Weiss², Charlotte Bouzbib¹, Dominique Thabut³

Affiliations

¹ Brain Liver Salpêtrière Study Group, Sorbonne Université, INSERM UMR_S 938, Centre de Recherche Saint-Antoine & Institute of Cardiometabolism and Nutrition (ICAN), Paris 75013, France; AP-HP, Sorbonne Université, Liver Intensive Care Unit, Hepatogastroenterology Department, Pitié-Salpêtrière Hospital, 47-83 Boulevard de l'Hôpital, Paris 75013, France.
² Brain Liver Salpêtrière Study Group, Sorbonne Université, INSERM UMR_S 938, Centre de Recherche Saint-Antoine & Institute of Cardiometabolism and Nutrition (ICAN), Paris 75013, France; AP-HP, Sorbonne Université, Neurological Intensive Care Unit, Neurology Department, Pitié-Salpêtrière Hospital, 47-83 Boulevard de l'Hôpital, Paris 75013, France; Sorbonne Université, Paris F-75005, France.
³ Brain Liver Salpêtrière Study Group, Sorbonne Université, INSERM UMR_S 938, Centre de Recherche Saint-Antoine & Institute of Cardiometabolism and Nutrition (ICAN), Paris 75013, France; AP-HP, Sorbonne Université, Liver Intensive Care Unit, Hepatogastroenterology Department, Pitié-Salpêtrière Hospital, 47-83 Boulevard de l'Hôpital, Paris 75013, France; Sorbonne Université, Paris F-75005, France. Electronic address: dominique.thabut@aphp.fr.

PMID: 33838857
DOI: 10.1016/j.cld.2021.01.008

Abstract

Hepatic encephalopathy (HE) is a severe complication of cirrhosis. The prevalence of overt HE (OHE) ranges from 30% to 45%, whereas the prevalence of minimal HE (MHE) is as high as 85% in some case series. Widespread use of transjugular intrahepatic portosystemic shunt to control complications related to portal hypertension is associated with an increase in HE incidence. If the diagnosis of OHE remains simple in most cases, then the diagnosis of MHE is less codified because of many differential diagnoses with different therapeutic implications. This review analyzes current knowledge about the pathophysiology, diagnosis, and different therapeutic options of HE.

Keywords: Ammonemia; Cirrhosis; Hepatic encephalopathy; Minimal hepatic encephalopathy; Transjugular intrahepatic portosystemic shunt.

Publication types

Review

MeSH terms

Hepatic Encephalopathy* / diagnosis
Hepatic Encephalopathy* / epidemiology
Hepatic Encephalopathy* / etiology
Humans
Hypertension, Portal* / diagnosis
Hypertension, Portal* / therapy
Incidence
Liver Cirrhosis / complications
Portasystemic Shunt, Transjugular Intrahepatic*