Dr Sharma: Welcome to the 27th Asian Pacific Association for the Study of the Liver Annual Conference in New Delhi. This is the third time the conference has been organized in India. India has contributed a lot to prevention, treatment and spreading knowledge of liver disease across Asia. In alternate years, India organizes a single-topic conference on relevant issues in liver disease like portal hypertension, variceal bleeds, acute-on-chronic liver failure, and hepatitis B. India trains a lot of hepatologists in Asia through Schools of Hepatology, through fellowships, and offering awards to our Asian colleagues in the field.
Dr Sharma: Hepatic encephalopathy is a very common problem in patients with liver cirrhosis. Once it develops, it is associated with very high death rates, so it is always better to take preventive measures to prevent the development of hepatic encephalopathy. Primary prevention means preventing the first episode of hepatic encephalopathy. Secondary prevention means that once a patient has recovered from an episode of hepatic encephalopathy, measures are taken to prevent a recurrence. Primary prevention is very important because hepatic encephalopathy is associated with a high morbidity and mortality, as well as high costs and expenditure. For primary prevention, we select patients who are more prone to encephalopathy, such as those with advanced liver disease, patients with gastrointestinal bleeds, or patient with infections with their cirrhosis.
Dr Sharma: To avoid relapses, patients should have a high protein diet and ongoing therapy with lactulose and probiotics. Compliance is very important. Once a patient stops therapy and has a recurrence, the risk of further episodes of hepatic encephalopathy and mortality are increased.
Dr Sharma: Mild hepatic encephalopathy should be treated and the endpoint should be an improvement in minimal hepatic encephalopathy (MHE). It should be treated because it improves quality of life, prevents the onset of overt hepatic encephalopathy, and also improves survival in patients with liver cirrhosis.
Dr Sharma: Various studies have shown that inflammation plays an important role, and specifically neuroinflammation in the brain plays a role, in the development of hepatic encephalopathy. There is a large contribution of cytokines and inflammatory markers to the development of hepatic encephalopathy. Anti-inflammatory drugs have been tried in animal models and found to be useful in the prevention and treatment of hepatic encephalopathy. However, in humans, we cannot try anti-inflammatory drugs because they are associated with liver toxicity. Patients with cirrhosis are prone to liver toxicity, so many anti-inflammatory drugs cannot be used in humans.