Nontraditional Treatment of Hepatic Encephalopathy

Jasleen Singh; Brittney Ibrahim; Steven-Huy Han

doi:10.1016/j.cld.2024.01.007

Nontraditional Treatment of Hepatic Encephalopathy

Clin Liver Dis. 2024 May;28(2):297-315. doi: 10.1016/j.cld.2024.01.007. Epub 2024 Feb 15.

Authors

Jasleen Singh¹, Brittney Ibrahim², Steven-Huy Han³

Affiliations

¹ Department of Medicine, University of California at Los Angeles; Los Angeles, CA, USA. Electronic address: [email protected].
² Department of Surgery, University of California at Los Angeles; Los Angeles, CA, USA.
³ Department of Medicine, University of California at Los Angeles; Los Angeles, CA, USA; Department of Surgery, University of California at Los Angeles; Los Angeles, CA, USA.

PMID: 38548441
DOI: 10.1016/j.cld.2024.01.007

Abstract

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 studies are needed to routinely recommend many of these agents.

Keywords: Albumin dialysis; Ammonia; Branched chain amino acids; Fecal microbiota transplant; Liver transplantation; Nontraditional treatments; Probiotics; gut microbiome.

Publication types

Review

MeSH terms

Gastrointestinal Agents / therapeutic use
Hepatic Encephalopathy* / drug therapy
Hepatic Encephalopathy* / therapy
Humans
Lactulose / therapeutic use
Rifamycins* / therapeutic use
Rifaximin / therapeutic use

Substances

Gastrointestinal Agents
Rifamycins
Rifaximin
Lactulose