Hepatic encephalopathy: Novel insights into classification, pathophysiology and therapy

J Hepatol. 2020 Dec;73(6):1526-1547. doi: 10.1016/j.jhep.2020.07.013. Epub 2020 Oct 21.


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.

Keywords: Ammonia; Diagnosis; Hepatic encephalopathy; Management; Pathogenesis; Pathophysiology; Treatments.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Cost of Illness
  • Disease Management
  • Hepatic Encephalopathy* / classification
  • Hepatic Encephalopathy* / physiopathology
  • Hepatic Encephalopathy* / psychology
  • Hepatic Encephalopathy* / therapy
  • Humans
  • Kidney Failure, Chronic / complications*