Hepatic encephalopathy is a problem hiding in plain sight

Dr. Steven L Flamm

Professor of Medicine (Gastroenterology and Hepatology) and Surgery at

Northwestern University Feinburg School of Medicine

See Dr. Flamm explain the reasons for screening patients with cirrhosis for hepatic encephalopathy.

References: 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.

Neff GW, Kemmer N, Duncan C, Alsina A. Update on the management of cirrhosis—focus on cost-effective preventative strategies. Clinicoecon Outcomes Res. 2013;5:143-152.

Blei A, Córdoba J; The Practice Parameters Committee of the American College of Gastroenterology. Hepatic encephalopathy. Am J Gastroenterol. 2001;96(7):1968-1976.

Cicho┼╝-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. http://www.chronicliverdisease.org/disease_focus/enewsletters/HepCoEE_eNewsletter_2012_08.pdf. 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.