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

Opinion
Video

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.

  1. 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
  2. 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?
  3. 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?
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