Medical Treatment for HE

Sadly, many cases of Hepatic Encephalopathy can go undiagnosed in the first instances. Mood changes can often be misdiagnosed and treated as being a hormonal imbalance or even depression or anxiety. The earlier HE can be diagnosed the better the outcome. Even having Diabetes can bring about mood swings. However, even at this point, the brain damage may have already begun. Sadly there doesn’t appear to be a fixed a standard set of treatment for people with hepatic encephalopathy. As mentioned in the “Heretical thoughts into hepatic encephalopathy“ (on the first page), “The clinical evidence behind using lactulose for all severities of hepatic encephalopathy, which is currently considered the standard of care is poor and placebo-controlled trials for hepatic encephalopathy should be considered ethically sound”. So, what are the main courses of treatment?

Lactulose

So what does Lactulose actually do. Firstly it is a probiotic that stimulates the growth of health-promoting gut bacteria (e.g., Bifidobacterium and Lactobacillus spp.) and also inhibits the growth of pathogenic bacteria (e.g., certain clostridia). Lactulose is a synthetic sugar used to treat constipation. It is broken down in the colon into products that pull waterout from the bodyand into the colon. This water softens stools. Lactulose is also used to reduce the amount of ammonia in the blood of patients with liver disease. It works by drawing ammonia from the blood into the colon where it is removed from the body. There is a downside to having to use this medication, as the need to have to use the toilet. This can become embarrassing and bring about a high anxiety situation. This can happen at any time and will normally happen when there just isn’t a public toilet nearby or available, and then when you do find one, there’s no toilet paper available. So try and be prepared for such situations. I have always considered this condition to be classed as having an unseen medical disability. So, don’t be afraid to use a disabled toilet. Many private buildings, and non-public areas such as offices, and shop/staff restrooms have toilet facilities for their staff. In such an emergency, don’t be afraid to ask if you can use these. This card may be handy to use and show. It’s discreet and many places will allow you to use their facilities. This is a personal emergency and will hopefully prevent embarrassment and further stress. There is also a digital version that can be downloded for free. Just click on one of the cards above to assess the site.

Treatment

Rifaximin (Targaxan)

Rifaximin has a broad spectrum of activity against both gram-negative and gram-positive anaerobic and aerobic bacteria in the gut. As food is further broken down by these friendly bacteria, the production of ammonia is a by-product of this breakdown. Rifamimin acts to prevent the production of these bacteria, and so limit the amount of ammonia currently being produced in the gut. When Rifaximin is taken with Lactulose, this treatment may be effective for some people as Rifaximin can help limit the amount of diarrhoea. It is also prescribed as a medication for Irritable Bowel Syndrome, and Travellers Tummy (E. coli Diarrhea). However, it has been shown in America, that some people have stopped taking Lactulose due to its sweet taste, and because of the unfriendly diarrhoea side effects. More research is needed to understand the effectiveness of these drugs and to ascertain if the poor results are due to a lack of patient involvement. There is a rather nice video over in America on “HCP Live”, that talks about the use of both Lactulose and Rifaximin in the Treatment of HE, and well worth viewing. This can be viewed by clicking on the picture below to link to the site. This is best viewed in full screen mode:

At present, Rifaximin is recommended by the, “National Institute for Health and Care Excellence” to prevent the recurrence of over-hepatic encephalopathy. In practice, treatment

with Rifaximin should be considered in patients with persistent symptoms of encephalopathy despite lactulose or in lactulose-intolerant patients, or in those who have had two or

more episodes of over hepatic encephalopathy in the previous 6 months. Rifaximin and lactulose in combination control hepatic encephalopathy in most patients.

Sadly, my own experience of HE was poorly managed, and I was prescribed only lactulose, nothing of this condition was ever explained or spoken about. Not even my wife was

informed of these aggressive behaviour patterns or changes in mood even after many HE episodes. The understanding and the sharing of knowledge and information are vital if

relationships are to survive.

L-ornithine L-aspartate (LOLA)

L-ornithine-L-aspartate (LOLA) is a chemical that is broken down by the body to increase levels of two amino acids: ornithine and aspartic acid. Ornithine and aspartic acid help to reduce levels of a toxic chemical like ammonia in the blood. People use L-ornithine-L-aspartate for reduced brain function due to advanced liver disease (hepatic encephalopathy). It is also used for athletic performance, cirrhosis, and other purposes, but there is no good scientific evidence to support these uses. Don't confuse L-ornithine-L-aspartate with ornithine or aspartic acid, as these are not the same. So, how does it work? L-ornithine-L-aspartate increases the levels of ornithine and aspartic acid in the body. These amino acids help to reduce levels of a toxic chemicals like ammonia in the blood. Possibly Effective for Reduced brain function in people with advanced liver disease (hepatic encephalopathy). By taking L-ornithine-L-aspartate by mouth or by IV might reduce symptoms of this condition in people with a long-term liver disease condtions like cirrhosis. However, it does not seem to help those with short-term liver failure. IV products can only be given by a trained healthcare professional. It should be stated that a lot more research is needed on the use of LOLA in treating Hepatic Encephalopathy as some studies have found the use of LOLA in treating HE to be poor. This 2017 study by the “Cochrane Collaboration” concludes with, “The evidence we found was very weak, and so we are not confident that L-ornithine L-aspartate is of use for preventing or treating hepatic encephalopathy in people with cirrhosis”: https://www.cochrane.org/CD012410/LIVER_l-ornithine-l-aspartate-people-chronic-liver-disease-and-hepatic-encephalopathy-poor-brain A Word of Caution It’s becoming increasingly common for people with a liver condition to go in search of an elusive miracle cure, in the misguided hope that it will cure their condition and make things better. There are many so-called L-ornithine L-aspartate supplements available and being sold both online and over the counter. Don’t be tempted, save your money. No supplements should be taken without being prescribed by a healthcare professional.