Little progress has been made in the pharmacological management of patients with hepatic encephalopathy, partly because it is difficult to perform clinical trials in this group of patients. A new clinical trial now suggests that polyethylene glycol is more effective than the current standard first-line therapy in these patients.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$209.00 per year
only $17.42 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
References
Cordoba, J. et al. Characteristics, risk factors, and mortality of cirrhotic patients hospitalized for hepatic encephalopathy with and without acute-on-chronic liver failure (ACLF). J. Hepatol. 60, 275–281 (2014).
Moreau, R. et al. Acute-on-chronic liver failure is a distinct syndrome that develops in patients with acute decompensation of cirrhosis. Gastroenterology 144, 1426–1437 (2013).
Rahimi, R. S., Singal, A. G., Cuthbert, J. A. & Rockey, D. C. Lactulose vs polyethylene glycol 3350-electrolyte solution for treatment of overt hepatic encephalopathy: the HELP randomized clinical trial. JAMA Intern. Med. http://dx.doi.org/10.1001/jamainternmed.2014.4746.
American Association for the Study of Liver Disease & European Association for the Study of the Liver. Hepatic encephalopathy in chronic liver disease: 2014 practice guideline by the European Association for the Study of the Liver and the American Association for the Study of Liver Diseases. J. Hepatol. 61, 642–659 (2014).
Bass, N. M. et al. Rifaximin treatment in hepatic encephalopathy. N. Engl. J. Med. 362, 1071–1081 (2010).
Sharma, B. C. et al. A randomized, double-blind, controlled trial comparing rifaximin plus lactulose with lactulose alone in treatment of overt hepatic encephalopathy. Am. J. Gastroenterol. 108, 1458–1463 (2013).
Huang, E., Esrailian, E. & Spiegel, B. M. The cost-effectiveness and budget impact of competing therapies in hepatic encephalopathy—a decision analysis. Aliment. Pharmacol. Ther. 26, 1147–1161 (2007).
Hassanein, T. et al. Performance of the hepatic encephalopathy scoring algorithm in a clinical trial of patients with cirrhosis and severe hepatic encephalopathy. Am. J. Gastroenterol. 104, 1392–1400 (2009).
Romero-Gomez, M., Montagnese, S. & Jalan, R. Hepatic encephalopathy in patients with acute decompensation of cirrhosis and acute on chronic liver failure. J. Hepatol. http://dx.doi.org/10.1016/j.jhep.2014.09.005.
Bernal, W. et al. Arterial ammonia and clinical risk factors for encephalopathy and intracranial hypertension in acute liver failure. Hepatology 46, 1844–1852 (2007).
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
R.J. declares that he has been a consultant for Conatus Pharmaceuticals and Ocera Therapeutics Inc. He has collaborated on research with funding from research grants from Gambro, Grifols Inc., Norgine, Sequana Medical and Ocera Therapeutics. He has received speaker fees from Grifols Inc. and Norgine. He is the inventor of Ornithine Phenylacetate, which is licensed by UCL to Ocera Therapeutics. R.S. declares no competing interests.
Rights and permissions
About this article
Cite this article
Sawhney, R., Jalan, R. The gut is a key target of therapy in hepatic encephalopathy. Nat Rev Gastroenterol Hepatol 12, 7–8 (2015). https://doi.org/10.1038/nrgastro.2014.185
Published:
Issue Date:
DOI: https://doi.org/10.1038/nrgastro.2014.185
This article is cited by
-
Darmmikrobiom und Psyche: der Paradigmenwechsel im Konzept der Hirn-Darm-Achse
MMW - Fortschritte der Medizin (2016)
