Covert and Overt Hepatic Encephalopathy: Diagnosis and Management

Clin Gastroenterol Hepatol. 2015 Nov;13(12):2048-61. doi: 10.1016/j.cgh.2015.06.039. Epub 2015 Jul 9.


Hepatic encephalopathy (HE) is part of a spectrum of neurocognitive changes in cirrhosis. HE is divided into 2 broad categories based on severity: covert hepatic encephalopathy (CHE) and overt hepatic encephalopathy (OHE). CHE has a significant impact on a patient's quality of life, driving performance, and recently has been associated with increased hospitalizations and death. Likewise, OHE is associated with increased rates of hospitalizations and mortality, and poor quality of life. Given its significant burden on patients, care takers, and the health care system, early diagnosis and management are imperative. In addition, focus also should be directed on patient and family member education on the disease progression and adherence to medications. Treatment strategies include the use of nonabsorbable disaccharides, antibiotics (ie, rifaximin), and, potentially, probiotics. Other therapies currently under further investigation include L-ornithine-L-aspartate, ornithine phenylacetate, glycerol phenylbutyrate, molecular adsorbent recirculating system, and albumin infusion.

Keywords: Ammonia; Cirrhosis; Covert Hepatic Encephalopathy; Hepatic Encephalopathy; Lactulose; Overt Hepatic Encephalopathy; Rifaximin.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, Non-P.H.S.
  • Review

MeSH terms

  • Drug Therapy / methods
  • Early Diagnosis
  • Hepatic Encephalopathy / diagnosis*
  • Hepatic Encephalopathy / drug therapy*
  • Hepatic Encephalopathy / pathology
  • Humans
  • Medication Adherence
  • Secondary Prevention / methods