, Volume 22, Issue 6, pp 319–326 | Cite as

Pathophysiology, diagnosis, and management of hepatic encephalopathy

  • Christopher Sheasgreen
  • Lucy Lu
  • Ameen Patel


Hepatic encephalopathy (HE) is a common complication of cirrhosis of the liver. It is also extremely debilitating, with an untreated 3-year survival of only 23 %. While the exact pathophysiology of HE has yet to be elucidated, a number of contributing factors have been described. Abnormal levels and altered metabolism of ammonia play a central role. Recently, inflammation has also been identified as a contributor to HE. Improved understanding of the pathophysiology of HE is crucial, as current therapy centers on reduction of the body’s ammonia load. Lactulose is the first-line therapy for HE, with some antibiotics recently showing promise for improved outcomes in patients with HE. The role of anti-inflammatory therapies has yet to be evaluated.


Hepatic encephalopathy Ammonia Lactulose Antibiotics 



The authors thank Dr Hector Baillie for reviewing the manuscript.


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Copyright information

© Springer Basel 2014

Authors and Affiliations

  1. 1.Department of MedicineMcMaster UniversityHamiltonCanada

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