Diagnosis and management of hepatic encephalopathy : The French recommendations
© 2023 The Authors. Liver International published by John Wiley & Sons Ltd..
Hepatic encephalopathy (HE) is a frequent and severe complication of liver disease with poor patient outcomes. However, it is a poorly understood complication, with no consensus for diagnosis. Therefore, HE is often underdiagnosed. Differential diagnosis may be cumbersome because of non-specific symptoms, such as confusion, cognitive disorders, the aetiological factors of cirrhosis and comorbidities, which are often observed in cirrhotic patients. Therefore, an overt or covert form of HE should be systematically investigated. Advice is provided to drive patient work-up. Effective treatments are available to prevent or treat HE bouts, but the issue of single or combination therapy has not been resolved. Transjugular intrahepatic portosystemic shunt (TIPS) placement largely improved the prognosis of cirrhotic patients, but HE occurrence of HE is often a fear, even when post-TIPS HE can be avoided by a careful selection of patients and preventive treatment. HE is an indication of liver transplantation. However, its reversibility post-transplantation and the consequences of transplantation in patients with other causes of neurological disorders remain controversial, which supports the performance of an extensive work-up in expert centres for this subset of patients. The present guidelines assist clinicians in the diagnosis of the overt or covert form of HE to implement curative and preventive treatments and clarify which patients require referral to expert centres for consideration for liver transplantation. These guidelines are very clinically oriented and address different frequent clinical issues to help physicians make bedside decisions.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:43 |
|---|---|
| Enthalten in: |
Liver international : official journal of the International Association for the Study of the Liver - 43(2023), 4 vom: 30. Apr., Seite 750-762 |
| Sprache: |
Englisch |
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| Links: |
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| Themen: |
Ammonia |
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| Anmerkungen: |
Date Completed 21.03.2023 Date Revised 14.04.2023 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1111/liv.15510 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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NLM351361367 |
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| 100 | 1 | |a Thabut, Dominique |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Diagnosis and management of hepatic encephalopathy |b The French recommendations |
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| 500 | |a Date Revised 14.04.2023 | ||
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| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 2023 The Authors. Liver International published by John Wiley & Sons Ltd. | ||
| 520 | |a Hepatic encephalopathy (HE) is a frequent and severe complication of liver disease with poor patient outcomes. However, it is a poorly understood complication, with no consensus for diagnosis. Therefore, HE is often underdiagnosed. Differential diagnosis may be cumbersome because of non-specific symptoms, such as confusion, cognitive disorders, the aetiological factors of cirrhosis and comorbidities, which are often observed in cirrhotic patients. Therefore, an overt or covert form of HE should be systematically investigated. Advice is provided to drive patient work-up. Effective treatments are available to prevent or treat HE bouts, but the issue of single or combination therapy has not been resolved. Transjugular intrahepatic portosystemic shunt (TIPS) placement largely improved the prognosis of cirrhotic patients, but HE occurrence of HE is often a fear, even when post-TIPS HE can be avoided by a careful selection of patients and preventive treatment. HE is an indication of liver transplantation. However, its reversibility post-transplantation and the consequences of transplantation in patients with other causes of neurological disorders remain controversial, which supports the performance of an extensive work-up in expert centres for this subset of patients. The present guidelines assist clinicians in the diagnosis of the overt or covert form of HE to implement curative and preventive treatments and clarify which patients require referral to expert centres for consideration for liver transplantation. These guidelines are very clinically oriented and address different frequent clinical issues to help physicians make bedside decisions | ||
| 650 | 4 | |a Journal Article | |
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| 650 | 4 | |a ammonia | |
| 650 | 4 | |a cirrhosis | |
| 650 | 4 | |a hepatic encephalopathy | |
| 650 | 4 | |a liver transplantation | |
| 700 | 1 | |a Bouzbib, Charlotte |e verfasserin |4 aut | |
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| 700 | 1 | |a Haas, Manon |e verfasserin |4 aut | |
| 700 | 1 | |a Weiss, Nicolas |e verfasserin |4 aut | |
| 700 | 1 | |a Louvet, Alexandre |e verfasserin |4 aut | |
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| 700 | 1 | |a Duhalde, Véronique |e verfasserin |4 aut | |
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| 700 | 1 | |a Broucker, Thomas De |e verfasserin |4 aut | |
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| 700 | 1 | |a Leroy, Vincent |e verfasserin |4 aut | |
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| 700 | 1 | |a Larrey, Dominique |e verfasserin |4 aut | |
| 700 | 1 | |a Camus, Christophe |e verfasserin |4 aut | |
| 700 | 1 | |a Scatton, Olivier |e verfasserin |4 aut | |
| 700 | 1 | |a De Ledinghen, Victor |e verfasserin |4 aut | |
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