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Liver Disease: Unmanaged Condition Exacts a Heavy Toll

As liver disorders increase nationwide, a condition known as hepatic encephalopathy lurks in the background


Chronic liver disease, also known as cirrhosis, saps a body’s vitality. Worse, it can rob someone of his/her mind.

For about half of people with liver disease, the condition leads to the onset of hepatic encephalopathy (HE), a disorder that causes confusion, forgetfulness and poor concentration. These impairments accelerate when doctors fail to recognize HE early or when they treat individual episodes instead of managing HE on ongoing basis to prevent recurrence. Many episodes of HE cause patients to be hospitalized.

HE occurs when a damaged liver fails to filter toxins in the body. Those toxins then invade the brain, potentially causing long-term mental impairment. In one study, only 26 percent of patients demonstrated an ongoing ability to learn new information once they had been diagnosed with HE.

The problem of HE is growing. Liver disease affects nearly six million people in the United States, and many of those people develop HE. More cases are reported every year.
Patients who don’t know they have liver-scarring hepatitis add to the population at risk for developing the condition, as do people who suffer from non-alcoholic fatty liver disease.


Manage HE as a long-term condition

New science and research make effective and affordable HE treatments available to liver disease patients, minimizing the condition’s effect on their lives.

“The key to treating HE is to actively manage it as a long-term condition,” said Dr. Arun Sanyal, chairman of the Division of Gastroenterology at Virginia Commonwealth University Medical Center. “More than anything, it’s about vigilance against recurrence.”

HE does not improve by itself and should be treated continuously with medication. Among the signs to look for in HE patients:

  • Loss of physical and mental control
  • Changes in personality or mood
  • Lapses in concentration and judgment
  • Shifts in sleep patterns and handwriting quality

People with liver disease, as well as their families and friends, should be on the lookout for a patient’s loss of mental acuity and act swiftly in response to these signs. If liver disease patients or their caregivers recognize any symptoms or signs of HE, they should consult a doctor immediately.


Few with HE treated outside the hospital

Unfortunately, though experts recommend treating HE continuously with prescription medication, many patients diagnosed with the condition are not receiving treatment. New data shows that outside of the hospital, 64 percent of patients who have been diagnosed with HE are not taking any prescription medication for their condition. This number includes patients who have had to be hospitalized for HE treatment in the past, yet are still not taking any prescriptions to manage HE.

Doctors often prescribe lactulose first when patients are diagnosed with HE because it used to be the only medication available. However, there are problems with this traditional HE treatment. Many patients who take lactulose experience uncomfortable side effects, such as diarrhea, bloating and sickness, making it difficult to stay on the medication long-term and increasing chances of HE recurrences. These symptoms also contribute to dehydration and may occasionally worsen HE rather than improve it.

When patients return home from the hospital, it doesn’t mean the battle with HE has ended. Three of every four patients taking lactulose develop recurring episodes of HE after their first episode, and many require additional hospitalization. In addition to the physical and mental toll of these recurring HE episodes, the financial burden is high as well. The average HE-related hospital stay is six days, costing roughly $38,000. Compounded by the fact that many patients can never return to work, HE can be financially devastating to a patient and his or her family.

Your physician can help find the best HE treatment options, including medicine that works over the long-term to manage HE. “If you suspect HE, tell your doctor,” Dr. Sanyal said. “The goal is to focus on long-term management, not a short-term fix.”

For more information about liver disease and hepatic encephalopathy, please visit www.liverfoundation.org.

Page updated: January 29th, 2013