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Hepatic encephalopathy: what the multidisciplinary team can do

Authors Liu A, Yoo ER, Siddique O, Perumpail RB, Cholankeril G, Ahmed A

Received 27 November 2016

Accepted for publication 9 February 2017

Published 24 March 2017 Volume 2017:10 Pages 113—119


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Scott Fraser

Andy Liu,1 Eric R Yoo,2 Osama Siddique,3 Ryan B Perumpail,4 George Cholankeril,5 Aijaz Ahmed4

1Department of Medicine, California Pacific Medical Center, San Francisco, CA, 2Department of Medicine, University of Illinois College of Medicine, Chicago, IL, 3Department of Medicine, Brown University, Providence, RI, 4Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA, 5Division of Gastroenterology and Hepatology, University of Tennessee Health Sciences Center, Memphis, TN, USA

Abstract: Hepatic encephalopathy (HE) is a complex disease requiring a multidisciplinary approach among specialists, primary care team, family, and caregivers. HE is currently a diagnosis of exclusion, requiring an extensive workup to exclude other possible etiologies, including mental status changes, metabolic, infectious, traumatic, and iatrogenic causes. The categorization of HE encompasses a continuum, varying from the clinically silent minimal HE (MHE), which is only detectable using psychometric tests, to overt HE, which is further divided into four grades of severity. While there has been an increased effort to create fast and reliable methods for the detection of MHE, screening is still underperformed due to the lack of standardization and efficient methods of diagnosis. The management of HE requires consultation from various disciplines, including hepatology, primary care physicians, neurology, psychiatry, dietician/nutritionist, social workers, and other medical and surgical subspecialties based on clinical presentation and clear communication among these disciplines to best manage patients with HE throughout their course. The first-line therapy for HE is lactulose with or without rifaximin. Following the initial episode of overt HE, secondary prophylaxis with lactulose and/or rifaximin is indicated with the goal to prevent recurrent episodes and improve quality of life. Recent studies have demonstrated the negative impact of MHE on quality of life and clinical outcomes. In light of all this, we emphasize the importance of screening and treating MHE in patients with liver cirrhosis, particularly through a multidisciplinary team approach.

Keywords: multidisciplinary, hepatic encephalopathy, management, multidisciplinary team

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