Recommendations Presented for Management of Hepatic Encephalopathy

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By Elana Gotkine HealthDay Reporter

Medically reviewed by Carmen Pope, BPharm. Last updated on March 17, 2026.

via HealthDay

TUESDAY, March 17, 2026 -- In a clinical guideline issued by the American College of Gastroenterology and published in the March issue of the American Journal of Gastroenterology, recommendations are presented for the diagnosis and management of hepatic encephalopathy (HE).

Jasmohan S. Bajaj, M.D., from the Virginia Commonwealth University and Richmond VA Medical Center, and colleagues present 24 recommendations for the diagnosis, management, and prevention of HE.

According to the recommendations, for patients being assessed for covert and minimal HE (CHE and MHE), a single-test strategy is suggested over a two-test combination strategy, and serum ammonia levels alone are not suggested to make the diagnosis. The evidence is insufficient to recommend for or against routine treatment of MHE/CHE for preventing overt HE (OHE). Treatment with lactulose is suggested versus no treatment in patients with MHE/CHE. Routine testing of serum ammonia is not suggested for guiding HE treatment decisions for inpatients with HE. To improve inpatient outcomes and prevent recurrence of OHE episodes, treatment with lactulose is recommended. Treatment with high-volume polyethylene glycol preparations is suggested as an alternative to lactulose in inpatients with OHE. Rifaximin is suggested as an addition to lactulose therapy in inpatients with acute OHE. For prevention of recurrence after an initial episode of OHE, lactulose titrated to two to three soft bowel movements daily is recommended as outpatient first-line therapy. Rifaximin therapy is suggested in the outpatient setting to prevent HE recurrence in patients with cirrhosis and OHE.

"Although current diagnostic and management strategies have made major strides, gaps remain in the appropriate identification of HE and to treat patients who are not responsive to currently available therapies," the authors write.

Several authors disclosed ties to the biopharmaceutical industry.

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Source: HealthDay

Posted : 2026-03-18 02:00

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