Author information

• ¹Addiction and Hepatology Unit/Alcohological Regional Centre and Study Centre "Self Help, Community Program and Caregiver Training" ASL3, Genoa, Italy - gianni.testino@asl3.liguria.it.
• ²General Direction, ASL3, Genoa, Italy.
• ³Liver Transplantation Unit, San Martino Polyclinic Hospital, Genoa, Italy.
• ⁴Unit of Neurology, ASL3, Genoa, Italy.
• ⁵Addiction and Hepatology Unit/Alcohological Regional Centre and Study Centre "Self Help, Community Program and Caregiver Training" ASL3, Genoa, Italy.
• ⁶Pharmacy Unit, San Martino Polyclinic Hospital, Genoa, Italy.
• ⁷Pharmacy Unit (territorial area), ASL3, Genoa, Italy.
• ⁸Sanitary Direction, ASL3, Genoa, Italy.
• ⁹Department of Translational Medicine, University of Ferrara, Ferrara, Italy.
• ¹⁰Center for the Study and Treatment of Chronic Inflammatory Intestinal Diseases (IBD) and Gastroenterological Manifestations of Rare Diseases, Department of Translational Medicine, University of Ferrara, Ferrara, Italy.
• ¹¹Center for the Study and Treatment of Alcohol-Related Diseases, Department of Translational Medicine, University of Ferrara, Ferrara, Italy.
• ¹²Department of Internal Medicine, Santissima Annunziata Hospital, University of Ferrara, Ferrara, Italy.
• ¹³Unit of Anesthesia and Resuscitation, ASL3, Genoa, Italy.
• ¹⁴Unit of Radiology, ASL3, Genoa, Italy.
• ¹⁵Department of Health Sciences, Infectious Diseases Clinic, IRCCS San Martino Polyclinic Hospital, University of Genoa, Genoa, Italy.
• ¹⁶Direction of the Health Professions, ASL3, Genoa, Italy.
• ¹⁷General Practioner, Genoa, Italy.
• ¹⁸Emergency Room Unit, ASL3, Genoa, Italy.
• ¹⁹Unit of Surgery, ASL3, Genoa, Italy.
• ²⁰Social Health Direction, ASL3, Genoa, Italy.
• ²¹Unit of Endocrinology, Metabolic Diseases and Diabetology, ASL3 Liguria, Genoa, Italy.
• ²²Pharmacy Unit (hospital area), ASL3, Genoa, Italy.
• ²³Unit of Gastroenterology, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy.

Abstract

Hepatic encephalophaty (HE) is a neuropsychiatric syndrome with a prevalence in the cirrhotic population ranging from 20 to 80%. HE is a cause of inappropriate hospitalization, caregiver burdening and increased social costs. There is need to create dedicated care pathways to better manage patients and support family caregivers. The data used for the preparation of this diagnostic therapeutic assistance path (DTAP) are based on a detailed analysis of the scientific literature published before June 30, 2022 (PubMed, Web of Science, Scopus, Google Scholar). Furthermore, in the process of developing this work, we consulted in particular the guidelines/ position papers of International Society for Hepatic Encephalopathy and Nitrogen Metabolism (ISHEN), Italian Association for the Study of the Liver (AISF), European Association for the Study of the Liver (EASL), American Association for the Study of Liver Diseases (AASLD), Italian Society on Alcohol (Società Italiana di Alcologia [SIA]) and other relevant papers. DTAP was created based on the most recent recommendations of the international scientific literature. The present DTAP highlight the need for a multidisciplinary activity integrated with territorial medicine in close connection with caregivers. This guarantees improved therapeutic adherence, hospital readmission reduction, improved quality of life for patients and caregivers and a significant reduction in costs.