Skip to main content

Advertisement

SpringerLink
Log in

Covert and Overt Hepatic Encephalopathy: Current Options for Diagnosis and Treatment

  • Portal Hypertension (K Brown, Section Editor)
  • Published:
Current Hepatology Reports Aims and scope Submit manuscript

Abstract

Overt hepatic encephalopathy (OHE) and covert hepatic encephalopathy (CHE) are two clinically distinct entities that are at the end of the spectrum of cognitive impairment due to portal hypertension. They are fraught with diagnostic and treatment challenges, but both could result in serious complications if not intervened upon in a timely fashion. CHE has been recognized as a harbinger to OHE providing an opportunity to intervene. There are numerous diagnostic strategies for CHE, and most require specialized equipment, trained personnel, and time. Diagnosis of OHE is significantly easier compared to CHE. As such, the psychometric tests have been more favored due to less dependence on specialized equipment and personnel, and their ability to be equally reliable compared to neuropsychological tests. While we have learned more about the pathophysiology of hepatic encephalopathy, our treatment modalities have not evolved as much. A collaborative approach to management, with development of easier reliable tests, will help us combat this epidemic.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Albrecht J. Hepatic encephalopathy in our genes? Ann Intern Med. 2010;153(5):335–6. doi:10.7326/0003-4819-153-5-201009070-00008.

    Article  PubMed  Google Scholar 

  2. Vilstrup H, Amodio P, Bajaj J, Cordoba J, Ferenci P, Mullen KD, et al. Hepatic encephalopathy in chronic liver disease: 2014 Practice Guideline by the American Association for the Study of Liver Diseases and the European Association for the Study of the Liver. Hepatology. 2014;60(2):715–35. doi:10.1002/hep.27210. AASLD/EASL guidelines on hepatic encephalopathy released in 2014.

    Article  PubMed  Google Scholar 

  3. Saxena N, Bhatia M, Joshi YK, Garg PK, Tandon RK. Auditory P300 event-related potentials and number connection test for evaluation of subclinical hepatic encephalopathy in patients with cirrhosis of the liver: a follow-up study. J Gastroenterol Hepatol. 2001;16(3):322–7.

    Article  CAS  PubMed  Google Scholar 

  4. Schomerus H, Hamster W. Quality of life in cirrhotics with minimal hepatic encephalopathy. Metab Brain Dis. 2001;16(1–2):37–41.

    Article  CAS  PubMed  Google Scholar 

  5. Bajaj JS, Cordoba J, Mullen KD, Amodio P, Shawcross DL, Butterworth RF, et al. Review article: The design of clinical trials in hepatic encephalopathy—an International Society for Hepatic Encephalopathy and Nitrogen Metabolism (ISHEN) consensus statement. Aliment Pharmacol Ther. 2011;33(7):739–47. doi:10.1111/j.1365-2036.2011.04590.x. ISHEN guidelines for conducting clinical trials in HE introducing the concept of covert HE.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  6. Ferenci P, Lockwood A, Mullen K, Tarter R, Weissenborn K, Blei AT. Hepatic encephalopathy—definition, nomenclature, diagnosis, and quantification: final report of the working party at the 11th World Congresses of Gastroenterology, Vienna, 1998. Hepatology. 2002;35(3):716–21. doi:10.1053/jhep.2002.31250.

    Article  PubMed  Google Scholar 

  7. Amodio P, Del Piccolo F, Petteno E, Mapelli D, Angeli P, Iemmolo R, et al. Prevalence and prognostic value of quantified electroencephalogram (EEG) alterations in cirrhotic patients. J Hepatol. 2001;35(1):37–45.

    Article  CAS  PubMed  Google Scholar 

  8. Groeneweg M, Moerland W, Quero JC, Hop WC, Krabbe PF, Schalm SW. Screening of subclinical hepatic encephalopathy. J Hepatol. 2000;32(5):748–53.

    Article  CAS  PubMed  Google Scholar 

  9. Romero-Gomez M, Cordoba J, Jover R, del Olmo JA, Ramirez M, Rey R, et al. Value of the critical flicker frequency in patients with minimal hepatic encephalopathy. Hepatology. 2007;45(4):879–85. doi:10.1002/hep.21586.

    Article  PubMed  Google Scholar 

  10. Lauridsen MM, Jepsen P, Vilstrup H. Critical flicker frequency and continuous reaction times for the diagnosis of minimal hepatic encephalopathy: a comparative study of 154 patients with liver disease. Metab Brain Dis. 2011;26(2):135–9. doi:10.1007/s11011-011-9242-1.

    Article  PubMed  Google Scholar 

  11. Sharma BC, Sharma P, Agrawal A, Sarin SK. Secondary prophylaxis of hepatic encephalopathy: an open-label randomized controlled trial of lactulose versus placebo. Gastroenterology. 2009;137(3):885–91, 91.e1. doi:10.1053/j.gastro.2009.05.056. Randomized trial showing lactulose is better than placebo in preventing OHE recurrence

  12. Das A, Dhiman RK, Saraswat VA, Verma M, Naik SR. Prevalence and natural history of subclinical hepatic encephalopathy in cirrhosis. J Gastroenterol Hepatol. 2001;16(5):531–5.

    Article  CAS  PubMed  Google Scholar 

  13. Saxena N, Bhatia M, Joshi YK, Garg PK, Dwivedi SN, Tandon RK. Electrophysiological and neuropsychological tests for the diagnosis of subclinical hepatic encephalopathy and prediction of overt encephalopathy. Liver. 2002;22(3):190–7.

    Article  PubMed  Google Scholar 

  14. Amodio P, Del Piccolo F, Marchetti P, Angeli P, Iemmolo R, Caregaro L, et al. Clinical features and survival of cirrhotic patients with subclinical cognitive alterations detected by the number connection test and computerized psychometric tests. Hepatology. 1999;29(6):1662–7. doi:10.1002/hep.510290619.

    Article  CAS  PubMed  Google Scholar 

  15. Genesca J, Gonzalez A, Segura R, Catalan R, Marti R, Varela E, et al. Interleukin-6, nitric oxide, and the clinical and hemodynamic alterations of patients with liver cirrhosis. Am JGastroenterol. 1999;94(1):169–77. doi:10.1111/j.1572-0241.1999.00790.x.

    Article  CAS  Google Scholar 

  16. Montoliu C, Piedrafita B, Serra MA, del Olmo JA, Urios A, Rodrigo JM, et al. IL-6 and IL-18 in blood may discriminate cirrhotic patients with and without minimal hepatic encephalopathy. J Clin Gastroenterol. 2009;43(3):272–9. doi:10.1097/MCG.0b013e31815e7f58.

    Article  CAS  PubMed  Google Scholar 

  17. Hassanein TI, Hilsabeck RC, Perry W. Introduction to the Hepatic Encephalopathy Scoring Algorithm (HESA). Dig Dis Sci. 2008;53(2):529–38. doi:10.1007/s10620-007-9895-0.

    Article  PubMed  Google Scholar 

  18. Jackson WT, Novack TA, Dowler RN. Effective serial measurement of cognitive orientation in rehabilitation: the Orientation Log. Arch Phys Med Rehabil. 1998;79(6):718–20.

    Article  CAS  PubMed  Google Scholar 

  19. Salam M, Matherly S, Farooq IS, Stravitz RT, Sterling RK, Sanyal AJ, et al. Modified-orientation log to assess hepatic encephalopathy. Aliment Pharmacol Ther. 2012;35(8):913–20. doi:10.1111/j.1365-2036.2012.05038.x. Modified Orientation log and outcomes in cirrhosis.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  20. Ortiz M, Cordoba J, Doval E, Jacas C, Pujadas F, Esteban R, et al. Development of a clinical hepatic encephalopathy staging scale. Aliment Pharmacol Ther. 2007;26(6):859–67. doi:10.1111/j.1365-2036.2007.03394.x. Clinical Hepatic Encephalopathy Staging Scale for outcomes.

    Article  CAS  PubMed  Google Scholar 

  21. Rockey DC, Vierling JM, Mantry P, Ghabril M, Brown Jr RS, Alexeeva O, et al. Randomized, double-blind, controlled study of glycerol phenylbutyrate in hepatic encephalopathy. Hepatology. 2014;59(3):1073–83. doi:10.1002/hep.26611. Glyceryl phenylbutyrate for prevention of recurrent HE after the second episode.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  22. Simon-Talero M, Garcia-Martinez R, Torrens M, Augustin S, Gomez S, Pereira G, et al. Effects of intravenous albumin in patients with cirrhosis and episodic hepatic encephalopathy: a randomized double-blind study. J Hepatol. 2013;59(6):1184–92. doi:10.1016/j.jhep.2013.07.020.

    Article  CAS  PubMed  Google Scholar 

  23. Wijdicks EF, Bamlet WR, Maramattom BV, Manno EM, McClelland RL. Validation of a new coma scale: the FOUR score. Ann Neurol. 2005;58(4):585–93. doi:10.1002/ana.20611.

    Article  PubMed  Google Scholar 

  24. Mouri S, Tripon S, Rudler M, Mallet M, Mayaux J, Thabut D, et al. FOUR score, a reliable score for assessing overt hepatic encephalopathy in cirrhotic patients. Neurocrit Care. 2015;22(2):251–7. doi:10.1007/s12028-014-0078-5.

    Article  CAS  PubMed  Google Scholar 

  25. Folstein MF, Folstein SE, McHugh PR. “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12(3):189–98.

    Article  CAS  PubMed  Google Scholar 

  26. Koziarska D, Wunsch E, Milkiewicz M, Wojcicki M, Nowacki P, Milkiewicz P. Mini-Mental State Examination in patients with hepatic encephalopathy and liver cirrhosis: a prospective, quantified electroencephalography study. BMC Gastroenterol. 2013;13:107. doi:10.1186/1471-230X-13-107.

    Article  PubMed Central  PubMed  Google Scholar 

  27. Hassanein T, Blei AT, Perry W, Hilsabeck R, Stange J, Larsen FS, et al. Performance of the hepatic encephalopathy scoring algorithm in a clinical trial of patients with cirrhosis and severe hepatic encephalopathy. Am J Gastroenterol. 2009;104(6):1392–400. doi:10.1038/ajg.2009.160. Hepatic Encephalopathy Scoring Algorithm for refining HE grading.

    Article  PubMed  Google Scholar 

  28. Strauss E, Tramote R, Silva EP, Caly WR, Honain NZ, Maffei RA, et al. Double-blind randomized clinical trial comparing neomycin and placebo in the treatment of exogenous hepatic encephalopathy. Hepato-Gastroenterology. 1992;39(6):542–5.

    CAS  PubMed  Google Scholar 

  29. Bajaj JS, Sanyal AJ, Bell D, Gilles H, Heuman DM. Predictors of the recurrence of hepatic encephalopathy in lactulose-treated patients. Aliment Pharmacol Ther. 2010;31(9):1012–7. doi:10.1111/j.1365-2036.2010.04257.x.

    CAS  PubMed  Google Scholar 

  30. Brigidi P, Swennen E, Rizzello F, Bozzolasco M, Matteuzzi D. Effects of rifaximin administration on the intestinal microbiota in patients with ulcerative colitis. J Chemother. 2002;14(3):290–5. doi:10.1179/joc.2002.14.3.290.

    Article  CAS  PubMed  Google Scholar 

  31. Sharma BC, Sharma P, Lunia MK, Srivastava S, Goyal R, Sarin SK. A randomized, double-blind, controlled trial comparing rifaximin plus lactulose with lactulose alone in treatment of overt hepatic encephalopathy. Am J Gastroenterol. 2013;108(9):1458–63. doi:10.1038/ajg.2013.219.

    Article  CAS  PubMed  Google Scholar 

  32. Bass NM, Mullen KD, Sanyal A, Poordad F, Neff G, Leevy CB, et al. Rifaximin treatment in hepatic encephalopathy. N Engl J Med. 2010;362(12):1071–81. doi:10.1056/NEJMoa0907893. Pivotal trial with rifaximin in preventing recurrence after the second HE episode.

    Article  CAS  PubMed  Google Scholar 

  33. Sanyal A, Younossi ZM, Bass NM, Mullen KD, Poordad F, Brown RS, et al. Randomised clinical trial: rifaximin improves health-related quality of life in cirrhotic patients with hepatic encephalopathy—a double-blind placebo-controlled study. Aliment Pharmacol Ther. 2011;34(8):853–61. doi:10.1111/j.1365-2036.2011.04808.x.

    Article  CAS  PubMed  Google Scholar 

  34. Morgan MH, Read AE, Speller DC. Treatment of hepatic encephalopathy with metronidazole. Gut. 1982;23(1):1–7.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  35. Tarao K, Ikeda T, Hayashi K, Sakurai A, Okada T, Ito T, et al. Successful use of vancomycin hydrochloride in the treatment of lactulose resistant chronic hepatic encephalopathy. Gut. 1990;31(6):702–6.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  36. De Marco F, Sanatamaria Amato P, D’arienzo A. Rifaximin in collateral treatment of port-systemic encephalopathy: a preliminary report. Curr Ther Res. 1984;36(4):668–74.

    Google Scholar 

  37. Parini P, Cipolla A, Ronchi M, Salzetta A, Mazzella G, Roda E. Effect of rifaximin and paromomycin in the treatment of portal-systemic encephalopathy. Curr Ther Res. 1992;52(1):34–9.

    Article  Google Scholar 

  38. Gluud LL, Dam G, Borre M, Les I, Cordoba J, Marchesini G, et al. Lactulose, rifaximin or branched chain amino acids for hepatic encephalopathy: what is the evidence? Metab Brain Dis. 2013;28(2):221–5. doi:10.1007/s11011-012-9372-0.

    Article  CAS  PubMed  Google Scholar 

  39. Gluud LL, Dam G, Borre M, Les I, Cordoba J, Marchesini G, et al. Oral branched-chain amino acids have a beneficial effect on manifestations of hepatic encephalopathy in a systematic review with meta-analyses of randomized controlled trials. J Nutr. 2013;143(8):1263–8. doi:10.3945/jn.113.174375.

    Article  CAS  PubMed  Google Scholar 

  40. Kircheis G, Nilius R, Held C, Berndt H, Buchner M, Gortelmeyer R, et al. Therapeutic efficacy of L-ornithine-L-aspartate infusions in patients with cirrhosis and hepatic encephalopathy: results of a placebo-controlled, double-blind study. Hepatology. 1997;25(6):1351–60. doi:10.1002/hep.510250609.

    Article  CAS  PubMed  Google Scholar 

  41. Bajaj JS, Etemadian A, Hafeezullah M, Saeian K. Testing for minimal hepatic encephalopathy in the United States: an AASLD survey. Hepatology. 2007;45(3):833–4. doi:10.1002/hep.21515.

    Article  PubMed  Google Scholar 

  42. Groeneweg M, Quero JC, De Bruijn I, Hartmann IJ, Essink-bot ML, Hop WC, et al. Subclinical hepatic encephalopathy impairs daily functioning. Hepatology. 1998;28(1):45–9. doi:10.1002/hep.510280108.

    Article  CAS  PubMed  Google Scholar 

  43. Prakash RK, Mullen KD. Is poor quality of life always present with minimal hepatic encephalopathy? Liver Int. 2011;31(7):908–10. doi:10.1111/j.1478-3231.2011.02532.x.

    Article  PubMed  Google Scholar 

  44. Bajaj JS, Pinkerton SD, Sanyal AJ, Heuman DM. Diagnosis and treatment of minimal hepatic encephalopathy to prevent motor vehicle accidents: a cost-effectiveness analysis. Hepatology. 2012;55(4):1164–71. doi:10.1002/hep.25507.

    Article  PubMed Central  PubMed  Google Scholar 

  45. Randolph C, Hilsabeck R, Kato A, Kharbanda P, Li YY, Mapelli D, et al. Neuropsychological assessment of hepatic encephalopathy: ISHEN practice guidelines. Liver Int. 2009;29(5):629–35. doi:10.1111/j.1478-3231.2009.02009.x.

    Article  PubMed  Google Scholar 

  46. Nabi E, Thacker LR, Wade JB, Sterling RK, Stravitz RT, Fuchs M, et al. Diagnosis of covert hepatic encephalopathy without specialized tests. Clin Gastroenterol Hepatol. 2014;12(8):1384.e2–9.e2. doi:10.1016/j.cgh.2013.12.020.

    Article  Google Scholar 

  47. Bajaj JS, Saeian K, Verber MD, Hischke D, Hoffmann RG, Franco J, et al. Inhibitory control test is a simple method to diagnose minimal hepatic encephalopathy and predict development of overt hepatic encephalopathy. Am J Gastroenterol. 2007;102(4):754–60. doi:10.1111/j.1572-0241.2007.01048.x.

    Article  PubMed  Google Scholar 

  48. Amodio P, Ridola L, Schiff S, Montagnese S, Pasquale C, Nardelli S et al. Improving the inhibitory control task to detect minimal hepatic encephalopathy. Gastroenterology. 2010;139(2):510–8, 8 e1-2. doi:10.1053/j.gastro.2010.04.057.

  49. Bajaj JS, Hafeezullah M, Zadvornova Y, Martin E, Schubert CM, Gibson DP, et al. The effect of fatigue on driving skills in patients with hepatic encephalopathy. Am JGastroenterol. 2009;104(4):898–905. doi:10.1038/ajg.2009.7.

    Article  Google Scholar 

  50. Mardini H, Saxby BK, Record CO. Computerized psychometric testing in minimal encephalopathy and modulation by nitrogen challenge and liver transplant. Gastroenterology. 2008;135(5):1582–90. doi:10.1053/j.gastro.2008.06.043.

    Article  PubMed  Google Scholar 

  51. Montagnese S, Schiff S, Turco M, Bonato CA, Ridola L, Gatta A, et al. Simple tools for complex syndromes: a three-level difficulty test for hepatic encephalopathy. Dig Liver Dis. 2012;44(11):957–60. doi:10.1016/j.dld.2012.06.010.

    Article  PubMed  Google Scholar 

  52. Sakamoto M, Perry W, Hilsabeck RC, Barakat F, Hassanein T. Assessment and usefulness of clinical scales for semiquantification of overt hepatic encephalopathy. Clin Liver Dis. 2012;16(1):27–42. doi:10.1016/j.cld.2011.12.005.

    Article  PubMed  Google Scholar 

  53. Amodio P, Schiff S, Del Piccolo F, Mapelli D, Gatta A, Umilta C. Attention dysfunction in cirrhotic patients: an inquiry on the role of executive control, attention orienting and focusing. Metab Brain Dis. 2005;20(2):115–27.

    Article  PubMed  Google Scholar 

  54. Bajaj JS, Thacker LR, Heuman DM, Fuchs M, Sterling RK, Sanyal AJ, et al. The Stroop smartphone application is a short and valid method to screen for minimal hepatic encephalopathy. Hepatology. 2013;58(3):1122–32. doi:10.1002/hep.26309. Stroop application for the diagnosis of minimal HE.

    Article  PubMed Central  PubMed  Google Scholar 

  55. Weissenborn K, Ennen JC, Schomerus H, Ruckert N, Hecker H. Neuropsychological characterization of hepatic encephalopathy. J Hepatol. 2001;34(5):768–73. Describing the Psychometric Hepatic Encephalopathy Score for minimal HE.

    Article  CAS  PubMed  Google Scholar 

  56. Torlot FJ, McPhail MJ, Taylor-Robinson SD. Meta-analysis: The diagnostic accuracy of critical flicker frequency in minimal hepatic encephalopathy. Aliment Pharmacol Ther. 2013;37(5):527–36. doi:10.1111/apt.12199. Critical flicker frequency for the diagnosis of minimal HE.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  57. Sharma P, Sharma BC, Sarin SK. Critical flicker frequency for diagnosis and assessment of recovery from minimal hepatic encephalopathy in patients with cirrhosis. Hepatobiliary Pancreat Dis Int. 2010;9(1):27–32.

    CAS  PubMed  Google Scholar 

  58. Sharma P, Singh S, Sharma BC, Kumar M, Garg H, Kumar A, et al. Propofol sedation during endoscopy in patients with cirrhosis, and utility of psychometric tests and critical flicker frequency in assessment of recovery from sedation. Endoscopy. 2011;43(5):400–5. doi:10.1055/s-0030-1256182.

    Article  CAS  PubMed  Google Scholar 

  59. Cunniffe N, Munby H, Chan S, Saatci D, Edison E, Carpenter RH, et al. Using saccades to diagnose covert hepatic encephalopathy. Metab Brain Dis. 2015. doi:10.1007/s11011-014-9647-8.

    PubMed  Google Scholar 

  60. Van der Rijt CC, Schalm SW, De Groot GH, De Vlieger M. Objective measurement of hepatic encephalopathy by means of automated EEG analysis. Electroencephalogr Clin Neurophysiol. 1984;57(5):423–6.

    Article  PubMed  Google Scholar 

  61. Amodio P, Pellegrini A, Ubiali E, Mathy I, Piccolo FD, Orsato R, et al. The EEG assessment of low-grade hepatic encephalopathy: comparison of an artificial neural network-expert system (ANNES) based evaluation with visual EEG readings and EEG spectral analysis. Clin Neurophysiol. 2006;117(10):2243–51. doi:10.1016/j.clinph.2006.06.714.

    Article  CAS  PubMed  Google Scholar 

  62. Amodio P, Marchetti P, Del Piccolo F, de Tourtchaninoff M, Varghese P, Zuliani C, et al. Spectral versus visual EEG analysis in mild hepatic encephalopathy. Clin Neurophysiol. 1999;110(8):1334–44.

    Article  CAS  PubMed  Google Scholar 

  63. Kullmann F, Hollerbach S, Lock G, Holstege A, Dierks T, Scholmerich J. Brain electrical activity mapping of EEG for the diagnosis of (sub)clinical hepatic encephalopathy in chronic liver disease. Eur J Gastroenterol Hepatol. 2001;13(5):513–22.

    Article  CAS  PubMed  Google Scholar 

  64. Montagnese S, Amodio P, Morgan MY. Methods for diagnosing hepatic encephalopathy in patients with cirrhosis: a multidimensional approach. Metab Brain Dis. 2004;19(3–4):281–312.

    Article  PubMed  Google Scholar 

  65. Sidhu SS, Goyal O, Mishra BP, Sood A, Chhina RS, Soni RK. Rifaximin improves psychometric performance and health-related quality of life in patients with minimal hepatic encephalopathy (the RIME Trial). Am J Gastroenterol. 2011;106(2):307–16. doi:10.1038/ajg.2010.455.

    Article  CAS  PubMed  Google Scholar 

  66. Bajaj JS, Heuman DM, Wade JB, Gibson DP, Saeian K, Wegelin JA, et al. Rifaximin improves driving simulator performance in a randomized trial of patients with minimal hepatic encephalopathy. Gastroenterology. 2011;140(2):478–87. doi:10.1053/j.gastro.2010.08.061.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  67. Bajaj JS, Heuman DM, Sanyal AJ, Hylemon PB, Sterling RK, Stravitz RT, et al. Modulation of the metabiome by rifaximin in patients with cirrhosis and minimal hepatic encephalopathy. PLoS One. 2013;8(4), e60042. doi:10.1371/journal.pone.0060042.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  68. Riggio O, Amodio P, Farcomeni A, Merli M, Nardelli S, Pasquale C, et al. A model for predicting development of overt hepatic encephalopathy in patients with cirrhosis. Clin Gastroenterol Hepatol. 2015. doi:10.1016/j.cgh.2014.12.025.

    PubMed  Google Scholar 

Download references

Compliance with Ethics Guidelines

Conflict of Interest

Chathur Acharya declares no conflict of interest.

Jasmohan S. Bajaj has been a consultant for Salix, Merz, Norgine, and Grifols, unrelated to this article.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Author information

Authors and Affiliations

  1. Division of General Internal Medicine, Virginia Commonwealth University, Richmond, VA, USA

    Chathur A Acharya

  2. Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University and McGuire VA Medical Center, 1201 Broad Rock Boulevard, Richmond, VA, 23249, USA

    Jasmohan S Bajaj

Authors
  1. Chathur A Acharya
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jasmohan S Bajaj
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jasmohan S Bajaj.

Additional information

This article is part of the Topical Collection on Portal Hypertension

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Acharya, C.A., Bajaj, J.S. Covert and Overt Hepatic Encephalopathy: Current Options for Diagnosis and Treatment. Curr Hepatology Rep 14, 234–242 (2015). https://doi.org/10.1007/s11901-015-0277-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11901-015-0277-3

Keywords

Search

Navigation