Will my uncle’s hepatic encephalopathy improve over time?

Question

Hello doctor,

I am asking about my uncle, aged 62, who had a TIPS procedure done and developed overt hepatic encephalopathy after that. He becomes disoriented and talks irrelevantly at times. He is currently on Lactulose and Rifaximin 550 mg twice daily.

Is post-TIPS encephalopathy permanent, or can it improve over time?
Are there any warning signs we should watch before a full episode starts?
Also, is it safe for him to travel alone or drive once his mental status improves, or should those be avoided completely?

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

Your uncle’s symptoms are consistent with hepatic encephalopathy occurring after a TIPS (transjugular intrahepatic portosystemic shunt) procedure. This can happen because the TIPS creates a pathway that allows blood to bypass the liver, which means toxins such as ammonia may reach the brain more easily. Post-TIPS encephalopathy is not always permanent. Many patients improve with proper treatment and adjustment of medications.

Your uncle is already on the standard therapy: Lactulose, which helps remove ammonia through bowel movements, and Rifaximin, which reduces ammonia-producing gut bacteria. In some cases, doctors adjust the TIPS size or treat triggers such as infection, constipation, dehydration, or bleeding to improve symptoms.

Family members should watch for early warning signs of an episode, including:

Increasing forgetfulness or confusion.
Slurred or slowed speech.
Changes in sleep pattern (awake at night, sleepy in daytime).
Irritability or personality changes.
Hand flapping tremor (asterixis).

If these signs appear, early medical attention and ensuring regular medication can prevent progression. Regarding driving or traveling alone, caution is advised. Even when symptoms improve, mild cognitive slowing may persist and affect judgment or reaction time. Many specialists recommend avoiding driving until mental status is clearly stable and confirmed by the treating physician.

With consistent medication, monitoring for triggers, and regular follow-up, many patients with post-TIPS encephalopathy achieve better stability and fewer severe episodes over time.

I hope you are satisfied with my answer.

For further queries, you can consult me at iCliniq.

Thank you.