When should I consider referring a patient with Hepatitis E for specialist care?

Consider referring a patient with hepatitis E for specialist care if they develop severe or complicated disease, such as acute liver failure, or if they have underlying chronic liver disease that may be exacerbated by hepatitis E infection. Specialist referral is also appropriate if the patient is pregnant, as hepatitis E can cause severe outcomes in pregnancy. In general, patients with hepatitis E who have signs of decompensated liver disease (e.g., ascites, encephalopathy, gastrointestinal hemorrhage) should be referred urgently to a hepatologist or gastroenterologist with expertise in liver disease.

Note: The provided UK guideline excerpts focus primarily on hepatitis B and do not specifically address hepatitis E management or referral criteria. However, by analogy to hepatitis B and general hepatology principles, referral is warranted for severe disease, complications, or vulnerable populations such as pregnant women.