Topic Highlight
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Dec 18, 2015; 7(29): 2871-2879
Published online Dec 18, 2015. doi: 10.4254/wjh.v7.i29.2871
Advances in cirrhosis: Optimizing the management of hepatic encephalopathy
Andy Liu, Ryan B Perumpail, Radhika Kumari, Zobair M Younossi, Robert J Wong, Aijaz Ahmed
Andy Liu, Albert Einstein College of Medicine, Bronx, NY 10461, United States
Ryan B Perumpail, Radhika Kumari, Aijaz Ahmed, Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA 94305, United States
Zobair M Younossi, Center for Liver Diseases, Department of Medicine, Inova Fairfax Hospital, Falls Church, VA 22042, United States
Robert J Wong, Division of Gastroenterology and Hepatology, Alameda Health System - Highland Hospital Campus, Oakland, CA 94602, United States
Author contributions: Liu A, Perumpail RB and Ahmed A contributed to the study concept and design; Liu A and Perumpail RB contributed to the systematic review, data collection and drafting of the manuscript; Liu A, Perumpail RB, Kumari R, Younossi ZM, Wong RJ and Ahmed A contributed to the critical review of the manuscript; Perumpail RB and Ahmed A contributed to the revision and finalization of the manuscript.
Conflict-of-interest statement: We declare that we have no conflicts of interest.
Open-Access: 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:
Correspondence to: Aijaz Ahmed, MD, Associate Professor of Medicine, Medical Director Liver Transplant Program, Division of Gastroenterology and Hepatology, Stanford University School of Medicine, 750 Welch Road, Suite 210, Palo Alto, Stanford, CA 94305, United States.
Telephone: +1-650-4986091
Received: April 29, 2015
Peer-review started: May 8, 2015
First decision: September 8, 2015
Revised: October 24, 2015
Accepted: November 23, 2015
Article in press: November 25, 2015
Published online: December 18, 2015
Core Tip

Core tip: Hepatic encephalopathy (HE) is a major complication of cirrhosis resulting in significant socioeconomic burden, morbidity, and mortality. Management of acute overt HE (OHE) involves institution of lactulose, the preferred first-line therapy. In addition, prompt recognition and treatment of precipitating factors may result in complete resolution of acute episodes of OHE. Treatment goals include improvement of daily functioning and prevention of OHE recurrence. For secondary prophylaxis, intolerance to indefinite lactulose therapy may lead to non-adherence and has been identified as a precipitating factor for recurrent OHE. Rifaximin is an effective add-on therapy to lactulose for treatment and prevention of recurrent OHE.