How is hepatic encephalopathy treated?
Acute therapy for hepatic encephalopathy (HE) requires either removal or blockade of neurologically acting toxins produced in the gut.
Reduction of protein intake along with lactulose therapy to enhance ammonia excretion and reduce ammonia absorption is the mainstay of therapy.
Oral antibiotics, such as either neomycin or rifaximin, and amino acids l -ornithine and l -aspartate, are used as second-line agents to reduce gut bacterial levels and ammonia formation.
Long-term treatment of HE with medical therapies has only limited success and depends on whether the hepatic damage is reversible, static, or progressive.
Ultimately, the most effective therapy involves treatments directed at reversing the hepatic failure, including surgical shunting procedures and liver transplantation for selected individuals.