Hepatic encephalopathy

Hepatic encephalopathy is a neuropsychiatric syndrome that occurs in patients with liver disease. This Primer discusses the epidemiology, pathophysiology, diagnosis and treatment of hepatic encephalopathy, and discusses how this disorder affects the quality of life of patients. Hepatic encephalopathy (HE) is a prognostically relevant neuropsychiatric syndrome that occurs in the course of acute or chronic liver disease. Besides ascites and variceal bleeding, it is the most serious complication of decompensated liver cirrhosis. Ammonia and inflammation are major triggers for the appearance of HE, which in patients with liver cirrhosis involves pathophysiologically low-grade cerebral oedema with oxidative/nitrosative stress, inflammation and disturbances of oscillatory networks in the brain. Severity classification and diagnostic approaches regarding mild forms of HE are still a matter of debate. Current medical treatment predominantly involves lactulose and rifaximin following rigorous treatment of so-called known HE precipitating factors. New treatments based on an improved pathophysiological understanding are emerging.

Automated summary

Hepatic encephalopathy is a neuropsychiatric syndrome that occurs in patients with liver disease. It affects the quality of life of patients and is the most serious complication of decompensated liver cirrhosis. Ammonia and inflammation play key roles in the development of hepatic encephalopathy, leading to cerebral edema, oxidative/nitrosative stress, inflammation, and disturbances in brain networks. Lactulose and rifaximin are currently the main medical treatments.