Strategies for Managing Hepatitis and HE

Liver disease often results from hepatitis that manifests as either an acute event or as a chronic condition, the latter of which can culminate in organ failure, need for transplant, and even death. Hepatitis C virus (HCV) is the most common form of hepatitis, but only one in four patients suffering from it gets diagnosed. The CDC recently recommended that anyone born between 1945 and 1965 receive HCV antibody testing. As many as 1 million new cases of chronic HCV may be uncovered with this dictum. Nonalcoholic fatty liver disease (NAFLD) is another important cause of hepatitis and is the most common cause of elevated liver function tests. It’s expected to become the most common indication for liver transplantation by 2020. Based on current trends in NAFLD, there is great cause for concern on how best to manage these patients. Importantly, cirrhosis is a stage of NAFLD that has been associated with hepatic encephalopathy (HE), a condition associated with cognitive impairment that significantly reduces quality of life (QOL). Symptoms of HE range from subtly altered mental status to deep coma. The cyclical nature of the illness can be difficult to break and doesn’t resolve completely until a transplant is received or the patient dies. The direct and indirect costs of managing HE are rising, and admissions for HE have increased significantly over the past 8 years. Additionally, patients suffering from HE tend to relapse, which can further exacerbate problems. Hepatitis Treatments Becoming More Effective Neomycin, lactulose, and rifaximin are the only FDA-approved treatments for HE, but the therapeutic paradigm is ever-changing. Historically, treatment for overt HE has begun when...