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

Hepatic encephalopathy: Novel insights into classification, pathophysiology and therapy

Christopher F Rose  1 , Piero Amodio  2 , Jasmohan S Bajaj  3 , Radha Krishan Dhiman  4 , Sara Montagnese  2 , Simon D Taylor-Robinson  5 , Hendrik Vilstrup  6 , Rajiv Jalan  7
Affiliations
Review

Hepatic encephalopathy: Novel insights into classification, pathophysiology and therapy

Christopher F Rose et al. J Hepatol. 2020 Dec.

Abstract

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.

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Conflict of interest statement

Conflicts of interest Christopher Rose has research collaborations with Mallinckrodt and Neuractas and is an advisor for Axcella, Horizon Therapeutics, Lupin Pharma Canada, Morphocell Technologies, Neuractas, Sana Biotechnologies and Thoeris. Jasmohan Bajaj has research collaborations with Grifols, Valeant and Mallinckrodt. Sara Montagnese is an advisor for Umecrine, Meddey and Versantis and her group has received research funds from Alfasigma, Ogilvie, Falk and Merz. Simon Taylor-Robinson has had previous research collaborations with Merz GmbH (Frankfurt, Germany) and has spoken at Merz and Norgine-sponsored symposia. Rajiv Jalan has research collaborations with Yaqrit and Takeda. Rajiv Jalan is the inventor of OPA, which has been patented by UCL and licensed to Mallinckrodt. He is also the founder of Yaqrit Ltd, a spin out company from University College London. He is also a Founder of Thoeris Ltd. Other authors have no conflicts to declare. Please refer to the accompanying ICMJE disclosure forms for further details.

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