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Pathophysiology, diagnosis, and management of hepatic encephalopathy

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Abstract

Hepatic encephalopathy (HE) is a common complication of cirrhosis of the liver. It is also extremely debilitating, with an untreated 3-year survival of only 23 %. While the exact pathophysiology of HE has yet to be elucidated, a number of contributing factors have been described. Abnormal levels and altered metabolism of ammonia play a central role. Recently, inflammation has also been identified as a contributor to HE. Improved understanding of the pathophysiology of HE is crucial, as current therapy centers on reduction of the body’s ammonia load. Lactulose is the first-line therapy for HE, with some antibiotics recently showing promise for improved outcomes in patients with HE. The role of anti-inflammatory therapies has yet to be evaluated.

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Acknowledgments

The authors thank Dr Hector Baillie for reviewing the manuscript.

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  1. Department of Medicine, McMaster University, Hamilton, ON, Canada

    Christopher Sheasgreen, Lucy Lu & Ameen Patel

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  1. Christopher Sheasgreen
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Correspondence to Ameen Patel.

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Sheasgreen, C., Lu, L. & Patel, A. Pathophysiology, diagnosis, and management of hepatic encephalopathy. Inflammopharmacol 22, 319–326 (2014). https://doi.org/10.1007/s10787-014-0217-9

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