Author information

• ¹Hepato-Neuro Laboratory, CRCHUM, Université de Montréal, Montreal, Canada. Electronic address: Christopher.rose@umontreal.ca.
• ²Department of Medicine, University of Padova, Padova, Italy.
• ³Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University and McGuire VA Medical Center, Richmond, Virginia, USA.
• ⁴Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
• ⁵Department of Surgery and Cancer, St. Mary's Hospital Campus, Imperial College London, London, United Kingdom.
• ⁶Department of Hepatology and Gastroenterology, Aarhus University Hospital, Denmark.
• ⁷Liver Failure Group, Institute for Liver and Digestive Health, University College London, Royal Free Campus, London, United Kingdom; European Foundation for the Study of Chronic Liver Failure, Barcelona, Spain. Electronic address: r.jalan@ucl.ac.uk.

Abstract

Hepatic encephalopathy (HE) is a frequent and serious complication of both chronic liver disease and acute liver failure. HE manifests as a wide spectrum of neuropsychiatric abnormalities, from subclinical changes (mild cognitive impairment) to marked disorientation, confusion and coma. The clinical and economic burden of HE is considerable, and it contributes greatly to impaired quality of life, morbidity and mortality. This review will critically discuss the latest classification of HE, as well as the pathogenesis and pathophysiological pathways underlying the neurological decline in patients with end-stage liver disease. In addition, management strategies, diagnostic approaches, currently available therapeutic options and novel treatment strategies are discussed.