Author information

1 Department of Medicine, University of Padova, Italy. Electronic address: sara.montagnese@unipd.it.

2 Department of Surgery, Oncology and Gastroenterology, University of Padova, Italy.

3 Department of Medicine, University of Padova, Italy.

4 Division of Internal Medicine, Gastroenterology and Hepatology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy.

5 Department of Clinical and Experimental Medicine, University of Campania "L. Vanvitelli", Naples, Italy.

6 Unit of Metabolic Diseases & Clinical Dietetics, Department of Medical and Surgical Sciences, University of Bologna, Italy.

7 Division of Gastroenterology, Department of Clinical Medicine, La Sapienza University of Rome, Italy.

8 Clinical Pharmacology & Digestive Pathophysiology Unit, Department of Clinical & Experimental Medicine, University of Parma, Italy.

Abstract

Hepatic encephalopathy (HE) is a common, worrisome and sometimes difficult to manage complication of end-stage liver disease. HE is often recurrent, requiring multiple hospital admissions. It can have serious implications in terms of a patient's ability to perform complex tasks (for example driving), their earning capacity, their social and family roles. This guideline reviews current knowledge on HE definition, pathophysiology, diagnosis and treatment, both by general principles and by way of a summary of available drugs and treatment strategies. The quality of the published, pertinent evidence is graded, and practical recommendations are made. Where possible, these are placed within the Italian health service context, with reference to local diagnosis and management experience.