Page 22 - Time to DeLiver: Getting a Grip on HE report 2015

SECTION 5
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Figure 2: Recommended treatment pathway for symptomatic hepatic encephalopathy (EASL/AASLD, 2014)
BCCAs, branched-chain amino acids; hepatic encephalopathy; ICU, intensive care unit; IV LOLA, intravenous
L-ornithine L-aspartate

Patient with possible symptomatic HE Not HE:
HE confirmed Alternative cause
of encephalopathy or
impairment identified

Precipitating factors MANAGEMENT OF HE Recurrent HE
& liver failure
Precipitating Admit to ICU for higher grades of HE
factors found (i.e. patients at risk or unable to protect Consider patient for
their airway) liver transplant
Direct treatment of
precipitating factor Initial therapy with:
• Lactulose (oral/enema)
Additional/alternative therapies:
• LBCAAs
• IV LOLA
Alternative therapies (short-term only):
• Neomycin
• Metronidazole
Prevention of HE recurrence/
maintenance of remission:
• Rifaximin

Calls to action

• Healthcare professionals should have the freedom to prescribe treatments to improve the
quality of life of their patients with hepatic encephalopathy through a flexible approach to suit
individual patients.

• Reimbursement for approved therapies is a priority to allow individualised care and support,
and to remove any financial barriers to accessing these treatments.

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