AASLD Guidelines for Hepatic Encephalopathy: Rifaximin's Role and Safety

Author(s):

Pamela Kushner, MD, FAAFP ,Nancy Reau, MD

The panel reviews the current American Association for the Study of Liver Diseases (AASLD) guideline recommendations for treating patients with hepatic encephalopathy (HE), and they also discuss the role of rifaximin, its ability to be prescribed by primary care clinicians, and its safety profile.

EP: 1.Exploring the Impact of Hepatic Encephalopathy on Patients and Their Families

EP: 2.Educating Primary Care Clinicians on Outpatient HE Management and Ammonia Testing

EP: 3.HE Experts on Symptoms, Risk Factors, Diagnosis Challenges, and Severity Grading

EP: 4.Collaborating with Specialists: Primary Care Clinician’s Evolving Role in HE Management

EP: 5.Preventing Cirrhosis Progression: Gut-Liver Axis, Circulation, Inflammation

EP: 6.Hepatic Encephalopathy: Exploring Alterations in Microbiota Caused by Liver Disease

EP: 7.Current Hepatic Encephalopathy Therapies Targeting Gut-Liver Axis Disturbance

Now Viewing

EP: 8.AASLD Guidelines for Hepatic Encephalopathy: Rifaximin's Role and Safety

EP: 9.Overview of Outpatient Strategies for Optimizing Patient Outcomes in HE

EP: 10.Managing Adverse Effects in HE Treatment

EP: 11.Practical Tips for the Primary Care Clinician Treating HE

EP: 12.Refractory Encephalopathy, Multivitamins and Closing Thoughts

What are the current American Association for the Study of Liver Diseases (AASLD) guideline recommendations on the treatment of patients with HE? Vilstrup et al 2014, EASL 2022
1. managing covert HE
2. managing overt HE
In primary care we are somewhat familiar with rifaximin. For patients with HE, can the primary care clinician prescribe it or does the hepatologist/gastroenterologist have to prescribe it?
1. What are some reasons why rifaximin is under prescribed by PCP’s?
2. What are strategies to help increase uptake?
3. What do we know about treatment adherence of rifaximin?
What data do we have on the safety and efficacy of rifaximin in HE? Yu et al 2021, Zacharias et al 2023
1. Alone and as combination therapy
2. How do you handle payer approval, what is required?