Hoilat GJ, Suhail FK, Adhami T, John S. Evidence-based approach to management of hepatic encephalopathy in adults. World J Hepatol 2022; 14(4): 670-681 [PMID: 35646276 DOI: 10.4254/wjh.v14.i4.670]
Corresponding Author of This Article
Gilles Jadd Hoilat, MBBS, Academic Fellow, Department of Medicine, SUNY Upstate Medical University, 750 E Adams St, Syracuse, NY 13210, United States. hoilatg@upstate.edu
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Evidence Review
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Hepatol. Apr 27, 2022; 14(4): 670-681 Published online Apr 27, 2022. doi: 10.4254/wjh.v14.i4.670
Evidence-based approach to management of hepatic encephalopathy in adults
Gilles Jadd Hoilat, Fathima Keshia Suhail, Talal Adhami, Savio John
Gilles Jadd Hoilat, Fathima Keshia Suhail, Department of Medicine, SUNY Upstate Medical University, Syracuse, NY 13210, United States
Talal Adhami, Department of Gastroenterology, Cleveland Clinic Foundation, Cleveland, OH 44195, United States
Savio John, Department of Gastroenterology, SUNY Upstate Medical University, Syracuse, NY 13210, United States
Author contributions: Hoilat GJ contributed to the manuscript conception and design, literature review, drafting of the manuscript, and submission of the manuscript; Hoilat GJ, Suhail FK, Adhami T, and John S contributed to the critical revision of the manuscript for important intellectual content; Adhami T and John S contributed to the study supervision; John S is responsible for the overall work as a guarantor.
Conflict-of-interest statement: We have no affiliations with any organization or entity with any financial or non-financial interest in the subject matter pertaining to this manuscript.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Gilles Jadd Hoilat, MBBS, Academic Fellow, Department of Medicine, SUNY Upstate Medical University, 750 E Adams St, Syracuse, NY 13210, United States. hoilatg@upstate.edu
Received: April 17, 2021 Peer-review started: April 17, 2021 First decision: July 27, 2021 Revised: August 7, 2021 Accepted: March 25, 2022 Article in press: March 25, 2022 Published online: April 27, 2022 Processing time: 369 Days and 16.3 Hours
Abstract
Hepatic encephalopathy (HE) is a reversible syndrome of impaired brain function and represents one of the many complications of portal hypertension and decompensated liver disease. Although ammonia is clearly implicated in the pathogenesis of HE, the pathogenesis of HE is multifactorial with numerous mechanisms that results in functional impairment of neuronal cells. The initial management of HE focuses on supportive care and stabilization which includes providing appropriate nutritional support. Thereafter, focus should be on identifying and treating the precipitating factors. There are many therapeutic agents available for the management of HE, most of which are directed towards lowering the gut nitrogen load and thus the serum ammonia level. This review aims to provide an update on the conventional and emerging treatment options for HE.
Core Tip: Hepatic encephalopathy (HE) is a reversible syndrome of impaired brain function and represents one of the many complications of portal hypertension and decompensated liver disease. This review provides an update on the conventional and emerging treatment options for HE. The different conventional and emerging therapeutic options available to date are detailed in the manuscript. We have elaborated all the data available in the literature about the use of fecal microbiota transplant in the treatment of HE.
