From the Guidelines
Hepatic encephalopathy should be treated by prioritizing the treatment of precipitating factors and initiating treatment with a non-absorbable disaccharide, such as lactulose or lactitol, in cirrhotic patients with overt hepatic encephalopathy. This approach is supported by the most recent and highest quality study, which recommends the use of non-absorbable disaccharides as the first-line treatment for hepatic encephalopathy 1. The treatment should focus on reducing ammonia levels and improving symptoms, with the goal of achieving two to three soft stools per day.
Key Considerations
- Identifying and treating precipitating factors, such as gastrointestinal bleeding, infection, electrolyte imbalances, or medication side effects, is crucial in managing hepatic encephalopathy 1.
- Non-absorbable disaccharides, such as lactulose or lactitol, are recommended as the initial therapeutic option due to their ability to reduce intestinal pH, increase the count of lactobacillus, and convert ammonia to ammonium, rendering it less absorbable 1.
- The dose of lactulose should be titrated to achieve two to three soft stools per day, with an initial dose of 30-45 mL every 1-2 hours until the patient is having at least 2 bowel movements a day 1.
- In severe cases, hospitalization may be required for closer monitoring and more aggressive treatment, and patients with recurrent or persistent hepatic encephalopathy should be considered for liver transplantation 1.
Monitoring and Follow-up
- Regular monitoring of ammonia levels, mental status, and liver function tests is necessary to track progress and adjust treatment as needed 1.
- Patients with hepatic encephalopathy should be followed up regularly to assess their response to treatment and to identify any potential precipitating factors that may need to be addressed 1.
From the FDA Drug Label
For the prevention and treatment of portal-systemic encephalopathy, including the stages of hepatic pre-coma and coma. The FDA drug label does not answer the question about "Her patio encephalopathy" as the term is not related to a medical condition described in the provided drug labels.
From the Research
Hepatic Encephalopathy Treatment
- The treatment of hepatic encephalopathy (HE) typically involves a combination of non-absorbable disaccharides, such as lactulose, and antibiotics, such as rifaximin 2, 3, 4, 5.
- Lactulose is often used as a first-line therapy for overt HE, with the goal of reducing blood ammonia levels and improving neurological function 2, 4.
- Rifaximin, an antibiotic, has been shown to be effective in combination with lactulose for the treatment of overt HE, with some studies suggesting improved outcomes and reduced mortality 3, 5.
- However, other studies have found that lactulose alone may be sufficient for some patients, particularly those with lower grades of encephalopathy 4.
Treatment Outcomes
- The effectiveness of combination therapy with rifaximin and lactulose versus lactulose alone has been evaluated in several randomized controlled trials, with mixed results 3, 4, 5.
- A systematic review and meta-analysis found that the use of rifaximin plus lactulose was associated with an increased incidence of effective rate and reduced risk of mortality compared to lactulose alone 5.
- However, another study found that patients treated with lactulose only had better outcomes and lower mortality rates compared to those treated with lactulose and rifaximin 4.
Pathophysiology and Classification
- Hepatic encephalopathy is a complex condition with a multifactorial pathogenesis, involving the accumulation of ammonia and other toxins, as well as inflammation and oxidative stress 6.
- The classification of HE is important for determining prognosis and guiding treatment, with various systems and assessments available, including the West Haven criteria and the Psychometric Hepatic Encephalopathy Score (PHES) 6.