Updates in the pathogenesis and diagnosis of hepatic encephalopathy

In the pathophysiology of hepatic encephalopathy (HE), a serious complication of liver cirrhosis, different hypotheses, including increased blood ammonia levels, increased production and absorption of intestinal bacterial products are discussed. Recent studies demonstrated that Helicobacter pylori infection is associated with elevated blood ammonia levels. Inflammatory mediators and cytokines also play important roles along with hyperammonia in the pathogenesis of HE, while recent studies revealed correlations between CRP levels and length of hospital stay. Neuropsychological diagnostic tests, such as Psychometric Hepatic Encephalopathy Score, were especially designed for detecting minimal HE. Imaging investigations, like Computed Tomography or Magnetic Resonance Imaging, show characteristic aspects in advanced stages of liver disease. Recent studies revealed that Mini-Mental State Examination (MMSE) can show significant changes mostly in advanced stages of overt HE, but that it is not an appropriate tool in defining an encephalopathy-related status of patients with cirrhosis.