After a first episode of overt hepatic encephalopathy, a structured secondary prophylaxis approach is indicated to guide ongoing management and reduce the risk of further episodes.
This protocol applies to patients with a documented history of a first episode of overt hepatic encephalopathy, for whom secondary prophylaxis is the primary clinical objective.
Management involves a titrated agent adjusted to reach a defined bowel movement frequency target per day. The full protocol specifies the agent, the titration approach, and the monitoring parameters.
Complete regimen details are available in the full protocol below.
DOI: 10.1016/j.jhep.2022.06.001
Lactulose is recommended as secondary prophylaxis following a first episode of overt HE, and should be titrated to obtain 2-3 bowel movements per day (LoE 1, strong recommendation, 96% consensus).
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