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Home > Your Liver > Liver Disease Information > Hepatic Encephalopathy

Hepatic Encephalopathy (HE)

Explore this section to learn more about Hepatic Encephalopathy (HE), how the condition is diagnosed, and methods of preventing recurrence.

Why is the liver important?

The liver is the second largest organ in your body and is located under your rib cage on the right side. It weighs about three pounds and is shaped like a football that is flat on one side.

The liver performs many jobs in your body. It processes what you eat and drink into energy and nutrients your body can use. The liver also removes harmful substances from your blood.

What is hepatic encephalopathy?

HE is a brain disorder, and one of the major complications of cirrhosis. There are two classifications for HE: mild and overt. The symptoms of mild HE are subtle and overlooked often by patients and family members. Overt HE is often marked by physical and mental symptoms such as confusion and issues with balance, and is a long-term, recurring condition.

What causes an episode of hepatic encephalopathy?

HE occurs when the liver is damaged and cannot remove toxic chemicals, such as ammonia, from the blood. These chemicals then enter the brain, affecting both the mental and physical condition of cirrhotic patients. Episodes of HE often result in hospitalization, and without treatment, patients remain at high risk for recurrence.

The following factors may trigger HE:

  • Dehydration (loss of water from the body)
  • Low oxygen levels in the body
  • Eating too much protein
  • Constipation
  • Medications that affect the nervous system, such as tranquilizers or sleep medications
  • Infections
  • Intestine, stomach, or esophagus bleeding
  • Kidney problems
  • Surgery

What are the symptoms of hepatic encephalopathy?

HE can cause mental and physical symptoms. They can vary person to person, and may progress slowly or occur suddenly.

Symptoms may include:

  • Mild confusion
  • Forgetfulness
  • Personality or mood changes
  • Poor concentration
  • Poor judgment
  • Stale or sweet odored breath
  • Change in sleep patterns
  • Worsening of handwriting or small hand movements

Severe symptoms may include:

  • Unusual movements or shaking of hands or arms (also known as “flapping”)
  • Extreme anxiety
  • Seizures
  • Severe confusion
  • Sleepiness or fatigue
  • Severe personality changes
  • Jumbled and slurred speech
  • Slow movement

What are the complications of hepatic encephalopathy?

Complications of HE may include:

  • Brain swelling
  • Permanent nervous system damage
  • Increased risk of heart failure, kidney failure, respiratory failure and sepsis (blood poisoning)
  • Coma

How is hepatic encephalopathy treated?

HE can be a medical emergency and hospitalization is usually required. It is important to see a doctor as soon as symptoms begin. At the hospital, doctors determine and treat what may have caused hepatic encephalopathy. Treatments aim to manage the disease and keep people out of the hospital and prevent recurrence.

Depending on the cause, treatments may include:

  • Stopping intestine, stomach, and esophagus bleeding
  • Healing infections
  • Addressing kidney failure
  • Providing life support if the person is in a coma

For people with chronic HE, doctors may recommend:

  • Diet changes such as avoiding too much or too little protein
  • Rifaximin (Xifaxan) to reduce bacteria in the intestines that make toxins the liver cannot process
  • Lactulose (type of sugar) to prevent the liver from absorbing toxins from the intestine
  • Prevention and treatment of constipation
  • Medicine to remove blood from the intestines or procedures to control active bleeding
  • Medicine to treat infections

What is the best way to reduce the risk of hepatic encephalopathy?

The best way to reduce the risk of HE is to prevent, treat, or manage liver disease. The risk of recurrence can be managed with maintenance/preventative therapy with lactulose and/or Xifaxan. Diet and lifestyle changes can also have an impact on reducing the threat of recurrence.

Talk to your doctor about risk factors and steps that can be taken to prevent chronic HE.

Why is maintenance therapy important in the treatment of HE?

HE is a serious condition, whose episodes often result in repeat hospitalizations. Once HE patients have experienced one episode, they are always at risk for recurrence. Studies have shown a reduction in the risk of repeat episodes in HE patients who are on preventative maintenance therapy such as lactulose and/or Xifaxan. Once a cirrhotic patient has had one HE episode, preventative maintenance therapy is recommended.

Facts-At-A-Glance

  • Hepatic encephalopathy (HE) is a brain disorder caused by liver damage
  • HE can be mild or overt
  • HE occurs when the liver cannot remove toxic chemicals in the blood and these chemicals enter the brain
  • Symptoms of HE may progress slowly, or may occur suddenly
  • Common symptoms of HE include confusion, forgetfulness, personality or mood changes, poor concentration and judgment, stale or sweet odored breath, change in sleep patterns, and worsening of handwriting or small hand movements
  • People with HE can enter a coma or have brain damage
  • HE can be a medical emergency and hospitalization is usually required
  • Treatments like lactulose and Rifaxamin (Xifaxan) aim to manage the disease and keep people out of the hospital
  • The best way to reduce the risk of HE is to prevent, treat, or manage liver disease and engage in preventative/maintenance therapy

Page updated: January 3rd, 2013