Optimal treatment of hepatic encephalopathy

Hepatic encephalopathy (HE) is a complex neuropsychiatric syndrome associated with decompensated liver disease. The spectrum of disease ranges from trivial abnormalities in complex decision-making and prolonged reaction time to coma in its most severe form. The very initial stages, recently termed covert hepatic encephalopathy, can only be diagnosed with the help of neuropsychiatric testing, while the later and more severe forms, termed overt hepatic encephalopathy, can be diagnosed clinically. Management of HE is very critical as it can dramatically increase morbidity and mortality. This leads to financial hardships, which tend to make matters worse. Timely management of HE will help diminish the disease burden and thus decrease morbidity and mortality. It is thus crucial that liver cirrhosis and HE are managed aggressively to try and lower the need for transplantation and other aggressive treatment measures.