Metabolic Brain Disease

, Volume 22, Issue 3, pp 389-405

First online:

The treatment of hepatic encephalopathy

  • Marsha Y. MorganAffiliated withCentre for Hepatology, Division of Medicine, Royal Free Campus, Royal Free and University College Medical School, University College London Email author 
  • , A. BleiAffiliated withNorthwestern University
  • , K. GrüngreiffAffiliated withHepatology Outpatient Practice
  • , R. JalanAffiliated withInstitute of Hepatology, Division of Medicine, Bloomsburg Campus, Royal Free and University College Medical School, University College London
  • , G. KircheisAffiliated withDepartment of Gastroenterology, Hepatology and Infectiology, Heinrich-Heine-University
  • , G. MarchesiniAffiliated withUnit of Clinical Dietetics, Alma Mater Studiorum University
  • , O. RiggioAffiliated withDepartment of Clinical Medicine, Division of Gastroenterology, University of Rome La Sapienza
  • , Karin WeissenbornAffiliated withDepartment of Neurology, Medical School Hannover

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Current recommendations for the treatment of hepatic encephalopathy are based, to a large extent, on open or uncontrolled trials, undertaken in very small numbers of patients. In consequence, there is ongoing discussion as to whether the classical approach to the treatment of this condition, which aims at reducing ammonia production and absorption using either non-absorbable disaccharides and/or antibiotics, should be revisited, modified or even abandoned. Pros and cons of present therapeutic strategies and possible future developments were discussed at the fourth International Hannover Conference on Hepatic Encephalopathy held in Dresden in June 2006. The content of this discussion is summarized.


Branched-chain amino acids Bromocriptine Hepatic cirrhosis Hepatic encephalopathy Non-absorbable antibiotics Non-absorbable disaccharides Ornithine aspartate Sodium benzoate Treatment Zinc