Hepatic encephalopathy

Reversible brain dysfunction in patients with severe liver failure or portosystemic shunts. Ammonia accumulation plays the central role. Manifestations range from sleep and attention disturbance to coma.

ICD-10 K72.91 drug

Also known as: HE, Portosystemic encephalopathy

Drugs used for this condition

BL-ornithine-L-aspartate (LOLA)Add-on therapy · Ammonia-lowering agent (L-ornithine-L-aspartate)L-ornithine-L-aspartate (LOLA) is a combined drug used in clinical hepatology, distinct from the free amino acid L-ornithine. EASL and AASLD in their joint 2014 guideline included LOLA as an adjunct option for overt hepatic encephalopathy in cirrhosis, in addition to lactulose and rifaximin. A Cochrane review in 2018 pooled 36 RCTs and found reduced mortality and improved psychometric tests with very low certainty and an uncertain result; the authors noted risk of bias in part of the studies. Self-administered consumer L-ornithine from iHerb does not substitute the hepatologist's prescription; the decision on LOLA is taken by the doctor after assessing the encephalopathy grade and liver function.

How to read tiers A–F

Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.

AStrong evidence – first or second line in international guidelines
BRecommended in selected cases
CStudy data contradict each other
DBenefit not proven, no documented harm
FDocumented harm, or risk without benefit