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1 Department of Gastroenterology, Hepatology and Infectious Diseases, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany. haeussin@uni-duesseldorf.de.
2 Department of Hepatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, (Uttar Pradesh), India.
3 Laboratory of Neurobiology, Centro de Investigación Principe Felipe, Valencia, Spain.
4 Department of Gastroenterology, Hepatology and Infectious Diseases, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
5 Liver Failure Group ILDH, Division of Medicine, UCL Medical School, Royal Free Campus, London, UK.
6 European Foundation for the Study of Chronic Liver Failure, Barcelona, Spain.
7 Department of Gastroenterology, Diabetology and Hepatology, University Hospital Brandenburg an der Havel, Brandenburg Medical School, Brandenburg an der Havel, Germany.
8 Department of Translational and Precision Medicine, Universita' degli Studi di Roma - Sapienza, Roma, Italy.
9 Department of Medicine, University of Padova, Padova, Italy.
10 UCM Digestive Diseases, Virgen del Rocío University Hospital, Institute of Biomedicine of Seville (HUVR/CSIC/US), University of Seville, Seville, Spain.
11 Institute of Clinical Neuroscience and Medical Psychology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
12 Department of Surgery and Cancer, St. Mary's Hospital Campus, Imperial College London, London, UK.
13 Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark.
1 Department of Gastroenterology, Hepatology and Infectious Diseases, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany. haeussin@uni-duesseldorf.de.
2 Department of Hepatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, (Uttar Pradesh), India.
3 Laboratory of Neurobiology, Centro de Investigación Principe Felipe, Valencia, Spain.
4 Department of Gastroenterology, Hepatology and Infectious Diseases, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
5 Liver Failure Group ILDH, Division of Medicine, UCL Medical School, Royal Free Campus, London, UK.
6 European Foundation for the Study of Chronic Liver Failure, Barcelona, Spain.
7 Department of Gastroenterology, Diabetology and Hepatology, University Hospital Brandenburg an der Havel, Brandenburg Medical School, Brandenburg an der Havel, Germany.
8 Department of Translational and Precision Medicine, Universita' degli Studi di Roma - Sapienza, Roma, Italy.
9 Department of Medicine, University of Padova, Padova, Italy.
10 UCM Digestive Diseases, Virgen del Rocío University Hospital, Institute of Biomedicine of Seville (HUVR/CSIC/US), University of Seville, Seville, Spain.
11 Institute of Clinical Neuroscience and Medical Psychology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
12 Department of Surgery and Cancer, St. Mary's Hospital Campus, Imperial College London, London, UK.
13 Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark.
Hepatic encephalopathy (HE) is a prognostically relevant neuropsychiatric syndrome that occurs in the course of acute or chronic liver disease. Besides ascites and variceal bleeding, it is the most serious complication of decompensated liver cirrhosis. Ammonia and inflammation are major triggers for the appearance of HE, which in patients with liver cirrhosis involves pathophysiologically low-grade cerebral oedema with oxidative/nitrosative stress, inflammation and disturbances of oscillatory networks in the brain. Severity classification and diagnostic approaches regarding mild forms of HE are still a matter of debate. Current medical treatment predominantly involves lactulose and rifaximin following rigorous treatment of so-called known HE precipitating factors. New treatments based on an improved pathophysiological understanding are emerging.
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Cordoba, J. et al. Characteristics, risk factors, and mortality of cirrhotic patients hospitalized for hepatic encephalopathy with and without acute-on-chronic liver failure (ACLF). J. Hepatol. 60, 275–281 (2014).
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Sawhney, R. et al. Role of ammonia, inflammation, and cerebral oxygenation in brain dysfunction of acute-on-chronic liver failure patients: Brain Dysfunction and ACLF. Liver Transpl. 22, 732–742 (2016).
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Wright, G., Sharifi, Y., Jover-Cobos, M. & Jalan, R. The brain in acute on chronic liver failure. Metab. Brain Dis. 29, 965–973 (2014).
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