Diagnosis and management of hepatic encephalopathy: The French recommendations.

Vincent Di Martino, Louise Barbier, Christophe Duvoux, Georges-Philippe Pageaux, Michael Bismuth, Damien Galanaud, Thomas De Broucker, Jean-François Cadranel, Vincent Leroy, Amélie Liou-Schischmanoff, Dominique Larrey, Christophe Camus, Olivier Scatton, Victor De Ledinghen, Ariane Mallat, Marika Rudler, Christophe Bureau, Antoine Santiago, Charlotte Bouzbib, Lucy Meunier, Manon Haas, Nicolas Weiss, Alexandre Louvet, Francois Imbert-Bismut, Fanny Mochel, Yann Nadjar, Dominique Thabut, Thierry Thevenot, Véronique Duhalde, Frédéric Oberti, Claire Francoz, Audrey Coilly, Marie-Noelle Hilleret, Pascal Lebray

Journal: Liver international : official journal of the International Association for the Study of the Liver 2023;43(4):750-762

PMID: 36625084

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Abstract

Hepatic encephalopathy (HE) is a frequent and severe complication of liver disease with poor patient outcomes. However, it is a poorly understood complication, with no consensus for diagnosis. Therefore, HE is often underdiagnosed. Differential diagnosis may be cumbersome because of non-specific symptoms, such as confusion, cognitive disorders, the aetiological factors of cirrhosis and comorbidities, which are often observed in cirrhotic patients. Therefore, an overt or covert form of HE should be systematically investigated. Advice is provided to drive patient work-up. Effective treatments are available to prevent or treat HE bouts, but the issue of single or combination therapy has not been resolved. Transjugular intrahepatic portosystemic shunt (TIPS) placement largely improved the prognosis of cirrhotic patients, but HE occurrence of HE is often a fear, even when post-TIPS HE can be avoided by a careful selection of patients and preventive treatment. HE is an indication of liver transplantation. However, its reversibility post-transplantation and the consequences of transplantation in patients with other causes of neurological disorders remain controversial, which supports the performance of an extensive work-up in expert centres for this subset of patients. The present guidelines assist clinicians in the diagnosis of the overt or covert form of HE to implement curative and preventive treatments and clarify which patients require referral to expert centres for consideration for liver transplantation. These guidelines are very clinically oriented and address different frequent clinical issues to help physicians make bedside decisions.

Address: APHP-Sorbonne Université, Service d'hépato-gastroentérologie, Hôpital Pitié-Salpêtrière. INSERM, Centre de Recherche Saint-Antoine (CRSA), Institute of Cardiometabolism and Nutrition (ICAN). Brain-Liver Pitié-Salpêtrière Study Group (BLIPS), Paris, France.; Service d'hépato-gastroentérologie A et Transplantation, Hôpital Saint-Eloi, CHU de Montpellier, Montpellier, France.; APHP-Paris Saclay, Centre Hépato-Biliaire, Hôpital Paul Brousse, Université Paris-saclay, Villejuif, France.; APHP-Sorbonne Université, Service de réanimation neurologique, Hôpital Pitié-Salpêtrière. INSERM, Centre de Recherche Saint-Antoine (CRSA), Institute of Cardiometabolism and Nutrition (ICAN). Brain-Liver Pitié-Salpêtrière Study Group (BLIPS), Paris, France.; Services des maladies de l'appareil digestif, CHRU de Lille, Lille, France.; APHP-Sorbonne Université, Service de biochimie, Hôpital Pitié-Salpêtrière, Paris, France.; APHP-Sorbonne Université, Service de génétique, Hôpital Pitié-Salpêtrière, Paris, France.; APHP-Sorbonne Université, Service de neurologie, Hôpital Pitié-Salpêtrière, Paris, France.; Service d'hépatologie, Hôpital Jean Minjoz, CHU de Besançon, Besançon, France.; Service de pharmacie, Hôpital Rangueil, CHU de Toulouse, Toulouse, France.; Laboratoire HIFIH, UPRES-EA2170, Faculté de Médecine, Service d'hépato-gastroentérologie, CHU ANGERS, Angers, France.; APHP-Hôpital Beaujon, Service d'hépatologie, Clichy, France.; Clinique d'Hépato-gastroentérologie, CHU de Grenoble, Grenoble, France.; APHP-Sorbonne Université, Service de pharmacie, Hôpital Pitié-Salpêtrière, Paris, France.; Service de chirurgie hépatique et transplantation, CHU de Tours, Tours, France.; APHP Hôpital Henri-Mondor, Service d'hépatologie, Créteil, France.; Service d'hépato-gastroentérologie B, Hôpital Saint Eloi, CHU de Montpellier, Montpellier, France.; APHP-Sorbonne Université, Service de neuro-radiologie, Hôpital Pitié-Salpêtrière, Paris, France.; Service de Neurologie Hôpital Pierre Delafontaine, Centre Hospitalier de Saint-Denis, Saint-Denis, France.; Service d'hépato-gastroentérologie de nutrition et d'Alcoologie-GHPSO site de Creil, Creil, France.; Service de réanimation Médicale, Hôpital Pontchaillou, CHU de Rennes, Rennes, France.; APHP-Sorbonne Université, Service de chirurgie et transplantation hépatique, Hôpital Pitié-Salpêtrière, Paris, France.; Service d'hépato-gastroentérologie, Hôpital du Haut-Lévêque, CHU de Bordeaux, Bordeaux, France.; Service d'hépatologie, Hôpital Rangueil, CHU de Toulouse, Toulouse, France.

DOI: 10.1111/liv.15510

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MeSH Terms: Humans, Hepatic Encephalopathy, Portasystemic Shunt, Transjugular Intrahepatic, Liver Cirrhosis, Risk Factors, Prognosis, Treatment Outcome