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: firstname.lastname@example.org.
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.