Management of Patients with Hepatic Encephalopathy

• For the management of recurrent or persistent hepatic encephalopathy (HE), use a medical treatment like nonabsorbable disaccharides + rifaximin and avoid precipitating factors.
• In patients refractory to treatment, consider spontaneous portosystemic shunts (SPSS) (abdominal CT/MRI).
• In the presence of SPSS and MELD score ≤11, no significant PHrelated complications and technical feasibility of embolization = consider embolization.
• In the presence of SPSS and model for end-stage liver disease (MELD) scores 12-14, consider each case individually. In the presence of SPSS and MELD score ≥15, significant PH-related complications, and technical difficulties for embolization = consider liver transplant.