Recognizing patients at risk for hepatic encephalopathy

Dr. Steven L Flamm

Professor of Medicine (Gastroenterology and Hepatology) and Surgery at

Northwestern University Feinburg School of Medicine

View Dr. Flamm speaking about the importance of recognizing the symptoms of HE on a wide spectrum of neurological and psychiatric manifestations.

References: Leise MD, Poterucha JJ, Kamath PS, Kim WR. Management of hepatic encephalopathy in the hospital. Mayo Clin Proc. 2014;89(2):241-253.

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.

Cichoż-Lach H, Michalak A. Current pathogenetic aspects of hepatic encephalopathy and noncirrhotic hyperammonemic encephalopathy. World J Gastroenterol. 2013;19(1):26-34.

Chronic Liver Disease Foundation. Hepatic encephalopathy update: prophylactic therapy to prevent hepatic encephalopathy. Accessed February 21, 2018

Flamm SL. Considerations for the cost-effective management of hepatic encephalopathy. Am J Manag Care. 2018;24(4 Suppl):S51-S61.

Jawaro T, Yang A, Dixit D, et al. Management of hepatic encephalopathy: a primer. Ann Pharmacother. 2016;50(7):569-577.


XIFAXAN® (rifaximin) 550 mg tablets are indicated for the reduction in risk of overt hepatic encephalopathy (HE) recurrence in adults and for the treatment of irritable bowel syndrome with diarrhea (IBS-D) in adults.

  • XIFAXAN is contraindicated in patients with a hypersensitivity to rifaximin, rifamycin antimicrobial agents, or any of the components in XIFAXAN. Hypersensitivity reactions have included exfoliative dermatitis, angioneurotic edema, and anaphylaxis.
  • Clostridium difficile-associated diarrhea (CDAD) has been reported with use of nearly all antibacterial agents, including XIFAXAN, and may range in severity from mild diarrhea to fatal colitis. If CDAD is suspected or confirmed, ongoing antibiotic use not directed against C. difficile may need to be discontinued.