For Patients Caregiver Tips and Advice For Medical Professionals

Treating Hepatic Encephalopathy

Once your doctor has determined you have HE, the first step is to identify and treat any factors that caused it.

Depending on the cause, treatment may include:

  • Medicine to treat infections
  • Procedures to stop active bleeding
  • Therapy for kidney problems
  • Stopping the use of certain medications that depress central nervous system function and can trigger HE

Once any precipitating factors have been addressed, treatment is aimed at lowering the level of ammonia and other toxins in your blood. Since these toxins originally arise in your gastrointestinal or GI system, therapies are aimed at your gut to eliminate or reduce the production of toxins. The two types of medications used to do this are lactulose, a man-made sugar, and antibiotics.

If you’ve been given a diagnosis of HE, it’s likely you’ve had liver disease for many years that progressed to cirrhosis, which means you’ve probably been under the care of a liver specialist. Liver specialists can include the following healthcare providers:

  • Hepatologists: Physicians who specialize in the treatment of people with liver diseases.
  • Gastroenterologists or GI: Physicians who specialize in the treatment of people with disorders of the digestive organs, including the liver.
  • Nurse Practitioners (NP) whose practice concentrates on people with liver disease. NPs are registered nurses who are prepared – through advanced education and clinical training – to assume some of the duties formerly assumed only by physicians. They can provide a wide range of healthcare services, including the diagnosis and management of common, as well as complex medical conditions.
  • Physicians Assistants (PA) whose practice concentrates on people with liver disease. PAs practice medicine under the supervision of a physician. They take medical histories, provide diagnostic screenings, order and interpret tests, prescribe medication and perform medical procedures.

Additionally, you may be followed by a primary care physician (PCP). These are internists or family physicians that provide preventative care and disease management, often in consultation with your liver specialist.

At times, you may be referred to other members of the healthcare team such as a:

  • Nutritionist or dietician for information about food intake and meal planning
  • Mental health therapist to help you deal with emotional issues such as depression and anxiety
  • Social worker or case manager to assist you in accessing health and social services such as Medicaid, disability and financial assistance

Because HE is a complicated condition, a multidisciplinary approach is often required to manage it.

For more information about healthcare providers, visit resource section, call our helpline at 1-800-465-4837 or consult your healthcare provider.

Being confronted with a diagnosis of HE can be overwhelming. And because the condition can affect your memory, concentration and thinking abilities, it’s best to bring a family member or friend with you to your appointment. Keep in mind that sometimes the changes or symptoms of HE are so minimal that your friends or family might notice them before you do. So it’s good to have someone with you who can help fill in the gaps about your recent symptoms and medical history.

In order to make the best use of time with your healthcare provider, it helps to come well-prepared. To prepare, refer to this checklist:

  • Write down any symptoms you’ve been experiencing, as well as the symptoms others around you may have noticed.
  • Include issues related to your job performance or driving abilities, even if you don’t think they’re related to the problem.
  • Bring a list of all the medications you’re currently taking. Include vitamins, supplements, herbs or home remedies.
  • Write down all your questions so you don’t forget to ask something important.

The therapies used for Hepatic Encephalopathy treatment vary depending upon a number of factors including:

  • The precipitating cause, or triggering event
  • Your specific symptoms
  • The severity of the disorder
  • The severity of your underlying liver disease
  • Your age and general health

The first step is to identify and treat precipitating factors such as infection, gastrointestinal (GI) bleeding, certain drugs or kidney dysfunction. Hepatic Encephalopathy treatment therapies may include medications to treat infections, medications or procedures to control bleeding, stopping the use of medications that can trigger an episode and any appropriate therapy for kidney issues.

If HE presents as a medical emergency requiring immediate hospitalization, life support may be necessary to help with breathing or blood circulation, particularly if there’s a loss of consciousness.

Once the precipitating factors have been addressed, treatment is aimed at lowering the level of ammonia and other toxins in your blood. Since these toxins originally arise in your GI system, therapies are aimed at your gut to eliminate or reduce the production of toxins. There are two types of medications that are used to do this: lactulose (a type of sugar) and antibiotics.

For more information about Hepatic Encephalopathy treatment consult your healthcare provider or call 1-800-GO-LIVER.

The two medicines used most often to treat HE are lactulose, a synthetic or man-made sugar, and certain antibiotics. Sometimes lactulose and antibiotics are used together.

  • Lactulose:
    • Works by drawing water from your body into your colon, which softens stools and causes you to have more bowel movements. This helps to lessen the absorption of toxins in your intestines by flushing toxins out of your system.
    • Reduces the amount of ammonia in your blood by drawing the ammonia into the colon where it is removed from the body.
    • Helps during HE recurrences and also makes them less likely to occur.
  • Antibiotics:
    • Work by stopping the growth of certain bacteria that create toxins from your digested food. By reducing these bacteria, antibiotics reduce the amount of toxins produced in your body.
    • Help to prevent HE recurrences and reduce the chance of being hospitalized due to HE.
    • A few different antibiotics are used to treat HE. Your healthcare provider will choose the one that’s best for you.

In order to get maximum benefit from your medications, it’s important to take them as prescribed – meaning taking the right dose, the right way, at the right time, for as long as necessary. With proper adherence to therapy, the progression of HE can be slowed and sometimes even stopped.

Adhering to other aspects of your treatment plan is also important. Communicating with members of your healthcare team, keeping your medical appointments, getting the necessary lab tests, and eating an appropriate diet will help to maximize your chance of treatment success and minimize potential problems.

The best way to reduce the risk of HE recurrence is to manage your liver disease and stay on maintenance therapy with lactulose and/or rifaximin, as directed by your doctor.

When the liver can no longer perform its vital functions a transplant may be the only option. A liver transplant replaces a damaged liver with a healthy one from someone else. Most of the time, a liver is donated from someone who has died. In rare cases, a living person donates a portion of their liver. Livers must be matched for blood type and body size.

There are many things that are taken into consideration when getting evaluated for a liver transplant. You need to be healthy enough to tolerate the surgery and recovery period – which is long – and have a support system in place that can help you through the process. Your doctor will determine if your liver disease is severe enough that referral for a transplant is appropriate.

For more information about liver transplants, call our helpline at 1-800-465-4837 or consult your healthcare provider.


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