What is Hepatic Encephalopathy?

Hepatic encephalopathy (or HE) is an organic condition of the brain that can cause all manner of mental and cognitive abnormalities.  Generally the symptoms of sleepiness, impairment of memory, difficult with normal task such as math or driving. It can be subtle and sometimes be mistaken for everything from laziness to drunkenness.  Symptoms can even progress to coma with need for hospitalization and the support of a ventilator machine.

Who is at risk for Hepatic Encephalopathy?

HE is most common in patients with cirrhosis. The stiffness of the cirrhotic liver can often cause blood to bypass the liver rather than passing through it. This is problematic because the liver is responsible for removing toxins from the blood. If certain toxins or chemicals reach the brain in excess amounts confusion, sleepiness, or personality changes can result.  The most well known example is ammonia.  High ammonia levels in the brains of patients with cirrhosis is strongly associated with HE.

How is Hepatic encephalopathy diagnosed?

Unfortunately there is no one perfect test for HE. Generally if a patient has cirrhosis and has changes in personality, cognition, or attention, HE is suspected.  Asterixis is a rhythmic flapping of the palms seen in patients with over HE but does not have to be present to make the diagnosis.

How is encephalopathy treated?

To avoid the onset or worsening of encephalopathy liver patients should avoid dehydration, benzodiazapene medications, constipation, infection and bleeding.  Medical treatment revolves around decreasing the Ammonia produced and/or absorbed in the human colon.  Lactulose is a sweet non-absorbable disaccharide that acidifies the colon reducing the ability of ammonia to cross front he colon to the blood stream. This also has a laxative effect which cause loose stools which expel ammonia and excess ammonia producing bacteria front he body. The side effects can be bloating and excess diarrhea that could lead to dehydration and--ironically--worsened encephalopathy.  The goal is to take enough every day to produce 3 loose bowel movements each day.

Xifaxan is the only FDA approved medication for HE. Produced by Salix Pharmaceuticals Xifaxan is a poorly-absorbable antibiotic that presumably prevents overt HE episodes by decreasing the amount of ammonia-producing bacteria in the colon. It is very well  tolerated and can be combined with lactulose with good results. It appears to reduce HE related hospitalizations as well.

Hepatic Encephalopathy (HE)