Pharmacologic Management of Hepatic Encephalopathy

Hepatic encephalopathy is a common cause of morbidity and mortality among patients with decompensated liver cirrhosis . In this article, we review the history, mechanism, and evidence for first-line pharmacologic therapies for hepatic encephalopathy including nonabsorbable disaccharides , antibiotics, and electrolyte management. We also review newer, second-line therapies including polyethylene glycol , albumin, branched-chain amino acids, probiotics and fecal microbiota transplant, zinc, and l -ornithine- l -aspartate.