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Abstract Details
Diagnosis and management of hepatic encephalopathy: The French recommendations
Liver Int. 2023 Jan 10. doi: 10.1111/liv.15510. Online ahead of print.
1APHP-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.
2Service d'hépato-gastroentérologie A et Transplantation, Hôpital Saint-Eloi, CHU de Montpellier, Montpellier, France.
3APHP-Paris Saclay, Centre Hépato-Biliaire, Hôpital Paul Brousse, Université Paris-saclay, Villejuif, France.
4APHP-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.
5Services des maladies de l'appareil digestif, CHRU de Lille, Lille, France.
6APHP-Sorbonne Université, Service de biochimie, Hôpital Pitié-Salpêtrière, Paris, France.
7APHP-Sorbonne Université, Service de génétique, Hôpital Pitié-Salpêtrière, Paris, France.
8APHP-Sorbonne Université, Service de neurologie, Hôpital Pitié-Salpêtrière, Paris, France.
9Service d'hépatologie, Hôpital Jean Minjoz, CHU de Besançon, Besançon, France.
10Service de pharmacie, Hôpital Rangueil, CHU de Toulouse, Toulouse, France.
11Laboratoire HIFIH, UPRES-EA2170, Faculté de Médecine, Service d'hépato-gastroentérologie, CHU ANGERS, Angers, France.
12APHP-Hôpital Beaujon, Service d'hépatologie, Clichy, France.
13Clinique d'Hépato-gastroentérologie, CHU de Grenoble, Grenoble, France.
14APHP-Sorbonne Université, Service de pharmacie, Hôpital Pitié-Salpêtrière, Paris, France.
15Service de chirurgie hépatique et transplantation, CHU de Tours, Tours, France.
16APHP Hôpital Henri-Mondor, Service d'hépatologie, Créteil, France.
17Service d'hépato-gastroentérologie B, Hôpital Saint Eloi, CHU de Montpellier, Montpellier, France.
18APHP-Sorbonne Université, Service de neuro-radiologie, Hôpital Pitié-Salpêtrière, Paris, France.
19Service de Neurologie Hôpital Pierre Delafontaine, Centre Hospitalier de Saint-Denis, Saint-Denis, France.
20Service d'hépato-gastroentérologie de nutrition et d'Alcoologie-GHPSO site de Creil, Creil, France.
21Service de réanimation Médicale, Hôpital Pontchaillou, CHU de Rennes, Rennes, France.
22APHP-Sorbonne Université, Service de chirurgie et transplantation hépatique, Hôpital Pitié-Salpêtrière, Paris, France.
23Service d'hépato-gastroentérologie, Hôpital du Haut-Lévêque, CHU de Bordeaux, Bordeaux, France.
24Service d'hépatologie, Hôpital Rangueil, CHU de Toulouse, Toulouse, France.
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.
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