Treatment of Recurrent or Persistent Hepatic Encephalopathy in Liver Cirrhosis

When hepatic encephalopathy recurs or persists in a patient with liver cirrhosis despite adequate medical treatment, further management requires specific consideration of structural and nutritional factors beyond the initial treatment approach.

Clinical scenario: Recurrent or persistent hepatic encephalopathy in liver cirrhosis, occurring despite adequate medical treatment already in place.

Management in this situation may involve an interventional approach targeting portal-systemic shunt anatomy in appropriately selected stable patients, or a dietary protein source strategy — the precise eligibility criteria, alternatives, and full decision pathway are set out in the complete protocol.

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References

DOI: 10.1016/j.jhep.2022.06.001

Obliteration of accessible portal-systemic shunts in patients with cirrhosis with recurrent or persistent HE (despite adequate medical treatment) can be considered in stable patients with a MELD score <11 (LoE 4, weak recommendation, 100% consensus).

In patients with recurrent/persistent HE, replacement of animal protein with vegetable and dairy protein can be considered, provided that overall protein intake is not compromised and that patient's tolerance is considered (LoE 4, weak recommendation, 83% consensus).

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