Florida gastroenterologist warns about severe complications of untreated chronic liver disease

Chronic liver disease can lead to a condition called Overt Hepatic Encephalopathy. Dr Salhab discusses the causes, symptoms and treatment options.

Every October marks Liver Awareness Month, a time dedicated to highlighting the crucial role the liver plays in maintaining overall health. Despite being one of the body’s most vital organs, liver disease often goes unnoticed until it reaches an advanced stage. Chronic liver disease, in particular, can progress silently over time, leading to severe complications if left untreated. Raising awareness, therefore, is essential - not just for prevention, but also for early diagnosis and timely care.

Dr Joseph Salhab, a gastroenterologist and health content creator from Florida, specialising in digestion, liver, pancreas and nutrition, is starting a conversation about the severe effects of chronic liver disease, in honour of Liver Awareness Month. In an Instagram video posted on October 20, he outlines the causes, symptoms, treatment options, and important safety instructions for Overt Hepatic Encephalopathy, caused by the progression of chronic liver disease.

He highlights, “Your liver does a lot of heavy lifting. It filters toxins. It supports digestion, regulates metabolism, and helps keep your body in balance every single day. October is liver awareness month. So, let's talk about it.”

Liver disease is more common than you think

According to Dr Salhab, “When the liver becomes damaged over time, it can lead to chronic liver disease, a condition that's affecting more and more people. Despite its prevalence, the condition is often misunderstood and stigmatised as it is often unfairly linked to lifestyle choices.” However, he highlights that liver disease can arise due to a range of factors and over 4.5 million people in the US are living with chronic liver disease, without being aware of it. The gastroenterologist adds, “Many don't realise how serious it can become due to lack of transparency around the condition.”

What is Overt Hepatic Encephalopathy (OHE)?

Dr Salhab states that with the progression of chronic liver disease, it can lead to liver cirrhosis or scarring of liver tissue, and one of the most serious complications of cirrhosis is Overt Hepatic Encephalopathy or OHE.

He explains, “OHE happens when the liver can't remove toxins from the blood effectively and these toxins build up and are thought to affect brain function leading to symptoms like confusion, personality changes, sleep disturbances, and more. It's a condition that can deeply impact both patients and caregivers.”

How to manage OHE?

According to the gastroenterologist, “The good news is that the risk of recurring OHE episodes can be managed. One option is Xifaxan, the first and only medicine approved to reduce the risk of OHE recurrence in adults.” However, Dr Salhab warns that Xifaxan is not meant for everyone. “Do not take Xifaxan if you have a known hypersensitivity to rifaximin, any of the rifamycin antimicrobial agents, or any of the components in Xifaxan,” he states.

Xifaxan 500 milligram tablets are used to reduce the risk of recurrence of OHE in adults.

Important safety instructions

Dr Salhab mentions that taking antibiotics like Xifaxan can cause side effects - “If you take antibiotics like Xifaxan, there is a chance you could experience diarrhoea caused by an overgrowth of bacteria (C. difficile). This can cause symptoms ranging in severity from mild diarrhoea to life-threatening colitis. Contact your health care provider if your diarrhoea does not improve or worsens.”

He advises consulting your healthcare provider before taking Xifaxan if you have severe liver impairment, as it may heighten the medicine’s effects.

He adds, “Tell your health care provider if you are taking drugs called P-glycoprotein and/or OATPs inhibitors (such as cyclosporine) because using these drugs with Xifaxan may lead to an increase in the amount of Xifaxan absorbed by your body.”

The most common side effects of using these medicines, as recorded in clinical studies are: Peripheral edema (swelling usually in the ankles or lower limbs), constipation, nausea (feeling sick to your stomach), fatigue (feeling tired), insomnia (trouble sleeping), ascites (a buildup of fluid in the abdomen), dizziness, urinary tract infection, anaemia (low red blood cell levels), and itching.

According to the safety instructions provided by the gastroenterologist, combining Xifaxan with anticoagulants like warfarin can interfere with its function. “Tell your healthcare provider if you are taking warfarin because the dose of warfarin may need to be adjusted to maintain proper blood-thinning effect.”

Xifaxan is also not recommended for pregnant or lactating mothers, or those planning to become pregnant, because it may cause harm to the unborn child or nursing infant.

Note to readers: This article is for informational purposes only and not a substitute for professional medical advice. It is based on user-generated content from social media. HT.com has not independently verified the claims and does not endorse them.