Nonpharmacologic Management of Hepatic Encephalopathy: An Update.

Vanessa Weir, K Rajender Reddy

Journal: Clinics in liver disease 2021;24(2):243-261

PMID: 32245531

Full Text on Elsevier Science View on PubMed

Abstract

Research increasingly shows that the gut-liver-brain axis is a crucial component in the pathophysiology of hepatic encephalopathy (HE). Due to the limitations of current standard-of-care medications, non-pharmacological treatments that target gut dysbiosis, including probiotics, nutritional management, and fecal microbiota transplants, are being considered as alternative and adjunct therapies. Meta-analyses note that probiotics could offer benefits in HE treatment, but have not shown superiority over lactulose. Emerging literature suggests that fecal microbiota transplants could offer a novel strategy to treat gut dysbiosis and favorably impact HE. Finally, liver support devices and liver transplantation could offer a last-resort treatment option for persistent HE.

Address: Division of Gastroenterology and Hepatology, Department of Medicine, University of Pennsylvania, Perelman Center for Advanced Medicine, 7 South Pavilion, 3400 Civic Center Boulevard, HUP, Philadelphia, PA 19104, USA.; Division of Gastroenterology and Hepatology, Department of Medicine, University of Pennsylvania, 2 Dulles, 3400 Spruce Street, HUP, Philadelphia, PA 19104, USA. Electronic address: [email protected].

DOI: 10.1016/j.cld.2020.01.003

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MeSH Terms: Amino Acids, Branched-Chain, Dietary Proteins, Energy Intake, Fecal Microbiota Transplantation, Gastrointestinal Microbiome, Hepatic Encephalopathy, Humans, Liver Transplantation, Liver, Artificial, Prebiotics, Probiotics, Synbiotics