Treatment of Hepatic Encephalopathy When Neuropsychological Tests Are Abnormal but Clinical Signs Are Absent or Minimal
Clinical Scenario
Covert hepatic encephalopathy presents with minor or no signs and symptoms while neuropsychological and/or neurophysiological testing reveals abnormalities — a picture that does not meet West Haven grade II criteria for overt HE.
Treatment Approach
Management involves a class of non-absorbable agents; anti-HE treatment is also considered to support differential diagnosis and to prevent progression to overt HE.
Full agent selection, sequencing, and clinical guidance are available in the structured protocol.
References
DOI: 10.1016/j.jhep.2022.06.001
- In terms of its severity, HE is qualified as covert (minor or no signs/symptoms but abnormalities on neuropsychological and/or neurophysiological tests) or overt (grades II or over according to the West Haven criteria).
- Patients with covert HE should be treated with non-absorbable disaccharides (LoE 3, strong recommendation, 92% consensus).
- In patients with covert HE, anti-HE treatment should be considered for the purposes of differential diagnosis and to prevent overt HE (LoE 5, strong recommendation, 89% consensus).
- On the other hand, in a situation where covert HE is suspected, even if not confirmed, treatment with non-absorbable disaccharides (and/or rifaximin) could be initiated and, if beneficial, also used as confirmation of the diagnosis (ex juvantibus).
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