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HE is commonly managed supportively by removing precipitating factors, using therapies such as lactulose and rifaximin. Despite conventional approaches, clinical efficacy remains suboptimal, and more effective agents are needed. Minimal/covert HE diagnosis and management are still debated, so this review summarizes novel pathogenetic mechanisms and emerging therapeutic targets, including fecal material transplantation, while covering classifications and etiologies.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/hepatic-encephalopathy-from-novel-pathogenesis-mechanism-to-emerging-treatments/436291/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/hepatic-encephalopathy-from-novel-pathogenesis-mechanism-to-emerging-treatments/436291.png","ImageObject",300,407,{"name":92,"@type":93},"Valentina","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-09-30","2026-09-29",true,{"@type":102,"interactionType":103,"userInteractionCount":8},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What is hepatic encephalopathy and who is most affected?","Question",{"text":112,"@type":113},"Hepatic encephalopathy is a potentially lethal complication of acute or chronic liver disease, most commonly occurring in cirrhotic patients with portal hypertension. Symptoms range from mild neuropsychiatric disturbances to severe cognitive dysfunction such as coma.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"How is hepatic encephalopathy typically managed, and what are the limitations?",{"text":117,"@type":113},"Management is primarily supportive and focuses on eliminating precipitating conditions. Common treatments include nonabsorbable disaccharides such as lactulose and antibiotics such as rifaximin, but therapeutic efficacy is still suboptimal, requiring novel agents.",{"name":119,"@type":110,"acceptedAnswer":120},"Which factors increase the risk of hepatic encephalopathy?",{"text":121,"@type":113},"Risk factors can be grouped into precipitating factors and predisposing factors. Precipitating factors include decompensated liver disease complications (e.g., acute-on-chronic liver failure, hepatorenal syndrome, gastrointestinal bleeding), infection, electrolyte imbalance, and constipation, while predisposing factors include lower albumin/bilirubin levels, covert HE, and prior episodes of overt HE.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},436291,1790763954,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":8,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":34,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":144},13056703020460,"https://ap-avatar.wpscdn.com/avatar/be000253dac470eee5d?_k=1778207105932848923","J Chin MedAssoc  \nReview ARticle  \nHepatic encephalopathy: From novel pathogenesis mechanism to emerging treatments  \nChon Kit Puna,b,d, Hui-Chun Huanga,b,d, Ching-Chih Changa,c, Shao-Jung Hsua,b,d,* , Yi-Hsiang Huanga,b, Ming-Chih Houa,b,d, Fa-Yauh Leea,b,d  \naFaculty of Medicine, National Yang Ming Chiao Tung University School of Medicine, Taipei, Taiwan, ROC; bDivision of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; cDivision of Holistic and Multidisciplinary Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; dTherapeutic and Research Center of Liver Cirrhosis and Portal Hypertension, Taipei Veterans General Hospital, Taipei, Taiwan, ROC  \nAbstract  \nHepatic encephalopathy (HE) is one of the major complications of liver disease and significantly affects the quality of life (QOL) of patients. HE is common and frequently relapses in cirrhotic patients. The management of HE is supportive, and precipitating conditions should be eliminated. Most drugs used to treat HE are conventional and include nonabsorbable disaccharides such as lactulose, and antibiotics such as rifaximin. However, their therapeutic efficacy is still suboptimal, and novel therapeutic agents are urgently needed. In addition, the optimal management and diagnosis of minimal HE/covert HE are under debate. In this review, we focus on novel pathogenetic mechanisms such as central nervous system clearance, and emerging therapeutic targets of HE, such as fecal material transplantation. We also discuss different classifications and etiologies of HE.  \nKeywords: Hepatic encephalopathy; Liver cirrhosis; Neuroinflammation; Portal hypertension  \n1. INTRODUCTION  \nHepatic encephalopathy (HE) is a potentially lethal complication resulting from acute or chronic liver disease, and it most commonly occurs in cirrhotic patients with portal hypertension. The symptoms of HE range from mild neuropsychiatric disturbances to severe cognitive dysfunction such as coma.1 HE is associated with a poor prognosis and significantly affects the quality of life (QOL) of cirrhotic patient. The severity of HE can be classified into four grades, and the concept of minimal HE has been proposed.1 It has been reported that 60% to 80% of cirrhotic patients exhibit mild cognitive impairment due to minimal HE and that 20% of patients will develop overt HE.2 In the pathogenesis of HE, ammonia and neuroinflammation play critical roles. Ammonia metabolism is disrupted in cirrhosis, and ammonia bypasses the liver through portosystemic shunting. As a result, ammonia accumulates in the brain and causes neuroinflammation via various mechanisms. This review addresses different aspects of HE from the incidence to management including novel pathogenetic mechanisms and emerging treatment strategies.  \n* Address correspondence. Dr. Shao-Jung Hsu, Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, 201, Section 2, Shi-Pai Road, Taipei 112, Taiwan, ROC. E-mail address: sjhsu@vghtpe. [gov.tw](gov.tw) (S.-J. Hsu).  \nConflicts of interest: Dr. Hui-Chun Huang, Dr. Ching-Chih Chang, Dr. Yi-Hsiang Huang, Dr. Ming-Chih Hou, and Dr. Fa-Yauh Lee, editorial board members at Journal of the Chinese Medical Association, have no roles in the peer review process of or decision to publish this article. The other authors declare that they have no conflicts of interest related to the subject matter or materials discussed in this article.  \nJournal of Chinese Medical Association. (2024) 87: 245-251.  \nReceived May 30, 2023; accepted July 9, 2023. doi: 10. 1097/JCMA.0000000000001041  \nCopyright © 2023, the Chinese Medical Association. This is an open access article under the CC BY-NC-ND license ([http://creativecommons.org/licenses/](http://creativecommons.org/licenses/)[ ](http://creativecommons.org/licenses/)[by-nc-nd/4.0/](by-nc-nd/4.0/))  \n2. INCIDENCE AND PREVALENCE  \nThe epi","cbCaiqpRrt2B7PQo","https://ap.wps.com/l/cbCaiqpRrt2B7PQo","pdf",516930,"English","# Introduction\n# Incidence and Prevalence\n# Risk Factors","[{\"question\":\"What is hepatic encephalopathy and who is most affected?\",\"answer\":\"Hepatic encephalopathy is a potentially lethal complication of acute or chronic liver disease, most commonly occurring in cirrhotic patients with portal hypertension. Symptoms range from mild neuropsychiatric disturbances to severe cognitive dysfunction such as coma.\"},{\"question\":\"How is hepatic encephalopathy typically managed, and what are the limitations?\",\"answer\":\"Management is primarily supportive and focuses on eliminating precipitating conditions. Common treatments include nonabsorbable disaccharides such as lactulose and antibiotics such as rifaximin, but therapeutic efficacy is still suboptimal, requiring novel agents.\"},{\"question\":\"Which factors increase the risk of hepatic encephalopathy?\",\"answer\":\"Risk factors can be grouped into precipitating factors and predisposing factors. Precipitating factors include decompensated liver disease complications (e.g., acute-on-chronic liver failure, hepatorenal syndrome, gastrointestinal bleeding), infection, electrolyte imbalance, and constipation, while predisposing factors include lower albumin/bilirubin levels, covert HE, and prior episodes of overt HE.\"}]","Hepatic encephalopathy: From novel pathogenesis mechanism to emerging treatments | PDF",1790677492,18]