seen

seen

CLD and Cirrhosis

Cirrhosis affects ~630,000 Americans and can cause complications such as hepatic encephalopathy.4

  • Mortality rate is high for these patients5

un seen
seen

seen

HE at a Glance

HE can occur in patients with compromised liver function who are unable to adequately filter toxins in the blood.1

  • HE can eventually progress into overt HE (OHE) and cause more severe symptoms1

un seen
seen

seen

The Impact of OHE

OHE is associated with frequent hospitalizations and may cause persistent cognitive defects.2,9

  • 53% of HE episodes required hospitalization in 20162
  • Numerous episodes of HE can result in persistent deficits in reaction time, working memory, response inhibition, and divided attention9

un seen
seen

seen

Identifying Patients With OHE

Patients with OHE can become comatose and require urgent medical care and a plan for managing the possibility of future recurrence.1


un seen
seen

seen

Managing OHE

OHE may be primarily managed by a specialist—often a gastroenterologist or a hepatologist.

  • Controlling precipitating factors of HE (eg, recurrent infections or variceal hemorrhages) is the cornerstone of managing OHE1
  • Lactulose is a common treatment for patients with OHE1

The role you play could go a long way.

Your patients and fellow healthcare professionals need your help to manage OHE.

  • Coordinate your care with your patients’ entire team of healthcare professionals
  • Learn what you can do to help minimize patients’ chances of OHE recurrence

Take Action Today

Nancy

When it comes to managing OHE, PCPs and specialists need to be on the same team, working together. Communication by itself can be a powerful tool. A text or email or quick call to the office with a little update can go a long way.

—Nancy Reau, MD Professor, Department of Internal Medicine, Division of Digestive Diseases and Nutrition, Rush Medical College Section Chief, Hepatology

References:
  1. Vilstrup H, Amodio P, Bajaj J, et al. Hepatic encephalopathy in chronic liver disease: 2014 practice guideline by the American Association for the Study of Liver Diseases and the European Association for the Study of the Liver. Hepatology. 2014;60(2):715-735.
  2. Data on file. Salix Pharmaceuticals. Bridgewater, NJ.
  3. Bustamante J, Rimola A, Ventura PJ, et al. Prognostic significance of hepatic encephalopathy in patients with cirrhosis. J Hepatol. 1999;30(5):890-895.
  4. Scaglione S, Kliethermes S, Cao G, et al. The epidemiology of cirrhosis in the United States: a population-based study. J Clin Gastroenterol. 2015;49(8):690-696.
  5. Murphy S, Xu J, Kochanek KD, Arias E, Tejada-Vera B. Deaths: final data for 2018. Natl Vital Stat Rep. 2021;69(13):1-83.
  6. Wong RJ, Aguilar M, Cheung R, et al. Nonalcoholic steatohepatitis is the second leading etiology of liver disease among adults awaiting liver transplantation in the United States. Gastroenterology. 2015;148(3):547-555.
  7. Kim D, Li AA, Gadiparthi C, et al. Changing trends in etiology-based annual mortality from chronic liver disease, from 2007 through 2016. Gastroenterology. 2018;155(4):1154-1163.
  8. Tapper EB, Henderson JB, Parikh ND, et al. Incidence of and risk factors for hepatic encephalopathy in a population-based cohort of Americans with cirrhosis. Hepatol Commun. 2019;3(11):1510-1519.
  9. Bajaj JS, Schubert CM, Heuman DM, et al. Persistence of cognitive impairment after resolution of overt hepatic encephalopathy. Gastroenterology. 2010;138(7):2332-2340.
  10. Jepsen P, Ott P, Andersen PK, Sørensen HT, Vilstrup H. Clinical course of alcoholic liver cirrhosis: a Danish population-based cohort study. Hepatology. 2010;51(5):1675-1682.

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Are you aware of hepatic encephalopathy (HE), the people who are at risk of developing HE, and the role you can play in managing it?

While HE may often be managed by a specialist, all clinicians can play a critical role in helping manage HE properly.

icon plusPatients with chronic liver disease (CLD) and cirrhosis are at risk for HE, a condition with high rates of hospitalization and mortality.1-3 You often see a large number of patients with a wide range of health conditions. These touchpoints may be opportunities to help patients living with HE.

What you see isn’t always as it seems. It’s the unseen that you also need to be aware of.

icon search The way a patient may present in the exam room may not tell the whole story. Uncovering what may be happening out of sight can help identify patients who may require medical intervention.

seen

CLD and Cirrhosis

Cirrhosis affects ~630,000 Americans and can cause complications such as hepatic encephalopathy.4

  • Mortality rate is high for these patients5

un seen

CLD and Cirrhosis

Causes and impact of CLD and cirrhosis may be surprising to some physicians.5-7

  • Causes of CLD and cirrhosis can vary and are not always caused by alcohol use6,7
  • In patients aged 25 to 54, CLD and cirrhosis had greater mortality than diabetes or stroke in 20175

seen

HE at a Glance

HE can occur in patients with compromised liver function who are unable to adequately filter toxins in the blood.1

  • HE can eventually progress into overt HE (OHE) and cause more severe symptoms1

un seen

HE at a Glance

HE is a likely complication for most patients with cirrhosis.1

  • Up to an estimated 80% of patients with cirrhosis will develop some form of HE over time1
  • The possibility of developing HE is higher in patients with cirrhosis who also have portal hypertension, ascites, or variceal bleeding, or who use opioids8
  • The risk for the first episode of OHE is 5%-25% within 5 years after a cirrhosis diagnosis1

seen

The Impact of OHE

OHE is associated with frequent hospitalizations and may cause persistent cognitive defects.2,9

  • 53% of HE episodes required hospitalization in 20192
  • Numerous episodes of HE can result in persistent deficits in reaction time, working memory, response inhibition, and divided attention9

un seen

The Impact of OHE

OHE readmission and mortality rates are high.2,3

  • In 2018, about 3 out of 5 hospitalized HE patients were under the age of 652
  • Average 30-day readmission rate for HE in 2019 was 38%2
  • 42% 1-year survival rate from time of OHE diagnosis3*†
  • 23% 3-year survival rate from time of OHE diagnosis3†

*1-year survival rates have been reported to be between 36% and 42%.3,10

Data from analysis published in 1999.


seen

Identifying Patients With OHE

Patients with OHE can become comatose and require urgent medical care and a plan for managing the possibility of future recurrence.1


un seen

Identifying Patients With OHE

Symptoms of HE may appear earlier than you may recognize.1
  • Some symptoms of HE can overlap with those of other forms of altered mental status, such as dementia or Alzheimer’s disease, which may delay the recognition and diagnosis of HE1
    • - Lethargy or apathy
    • - Disorientation for time
    • - Obvious personality change
    • - Inappropriate behavior
    • - Dyspraxia
    • - Asterixis
    • - Somnolence to semistupor
    • - Responsive to stimuli
    • - Confused
    • - Gross disorientation
    • - Bizarre behavior

If you have patients with CLD or cirrhosis who display the symptoms above, you should suspect HE after ruling out other potential immediate causes.

  • 30%-40% of cirrhosis patients will develop overt (clinically apparent) HE at some point during their clinical course1

seen

Managing OHE

OHE may be primarily managed by a specialist—often a gastroenterologist or a hepatologist.

  • Controlling precipitating factors of HE (eg, recurrent infections or variceal hemorrhages) is the cornerstone of managing OHE1
  • Lactulose is a common treatment for patients with OHE1

un seen

Managing OHE

You may see patients with HE regularly, which means that you can play a critical role in caring for these patients.

Communication between physicians can help ensure that patients are receiving the attention and care they need and that there is a consistent long-term strategy in place to help patients manage the likelihood of OHE recurrence.

  • Consider calling, texting, or emailing the other members of your patient’s care team with updates or questions to discuss:
    • - The patient’s OHE symptoms
    • - History of hospitalization due to HE
    • - The need for additional evaluation or follow-up
    • - Possibility of OHE recurrence
    • - Changes to the management strategy, including dietary and nutritional changes, lifestyle modification, and medication
  • Medical intervention can help minimize the chances of OHE recurrence and hospitalization involving HE1