Treatment guidelines for hepatic encephalopathy.

Practice guidelines for hepatic encephalopathy were developed and published in 2001 for overall management in adults. Hepatic encephalopathy is caused by nitrogenous substances from the gastrointestinal tract that adversely affect brain function. Hepatic encephalopathy is a diagnosis of exclusion. The West Haven criteria are recommended for staging the disease. Treatment goals are providing supportive care, identifying and removing precipitating factors, reducing nitrogenous load, and assessing long-term therapy needs. Data from some trials published before 2001 are not included in the guidelines. In addition, since the publication of the guidelines, new data have become available regarding treatment interventions and outcomes. Newer, nonabsorbed agents, such as rifaximin, alone or in conjunction with lactulose, may enhance compliance and adherence with therapy, and provide better treatment outcomes. New updated practice guidelines need to be developed for hepatic encephalopathy, along with treatment algorithms for patients with both minimal hepatic encephalopathy and overt hepatic encephalopathy.