What is hepatic encephalopathy?

Hepatic encephalopathy (HE) is a metabolic, potentially reversible, functional disturbance of the brain which may occur during the course of chronic or acute liver diseases. The clinical picture of HE is very variable and can be associated with impairment of intellectual and psychomotor functions and may lead to changes in personality and level of consciousness. The prerequisites for a diagnosis of HE are manifest liver disease, demonstrable impairment of CNS function, and the exclusion of other neuropsychiatric disorders. The early diagnosis of HE is of great importance for future management and treatment.1-3

Approximately 29 million people in the European Union currently suffer from a chronic liver condition:1

  • Around 14 million people have cirrhosis of the liver
  • On average up to 40% of patients develop manifest HE in the course of liver cirrhosis
  • The incidence of HE in patients with cirrhosis at some time during the course of the disease is 70% if minimal hepatic encephalopathy (MHE) is included

As there is no definitive test for HE, the prevalence is not clearly known. It has been reported that up to one third of cirrhotic patients have clinical findings consistent with the disease and up to two-thirds have a suggestive diagnosis.1-3 For this reason patients with cirrhosis should be carefully monitored for signs of HE.


1. Blachier M et al. The burden of liver disease in Europe: a review of available epidemiological data. J Hepatol. 2013;58(3):593-608.
2. Felipo V. Hepatic encephalopathy: effects of liver failure on brain function. Nat Rev Neurosci. 2013;14(12):851-8.
3. Poordad FF. Review article: the burden of hepatic encephalopathy. Aliment Pharmacol Ther. 2007;25 Suppl 1:3-9.