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Getting to Understand Hepatic Encepalopathy (HE)

Liver disease affects nearly six million people in the United States, and many of those people develop Hepatic Encephalopathy (HE). More cases of HE are reported every year.

To help you better understand what HE is, here’s a quick question and answer overview.

What is hepatic encephalopathy (HE)?

HE occurs in people with advanced cirrhosis or severe liver damage. The damaged liver can’t remove the toxins (ammonia) that a healthy liver normally would. These toxins can affect the brain and cause HE.

How are HE and liver disease connected?

Your liver filters everything that enters your body, such as food, drinks, and medicine. Your liver separates toxins from useful substances and sends nutrients and vitamins into your bloodstream. A damaged liver can’t filter out everything it’s supposed to, so toxins can build up and get into your brain. The buildup of these toxins in the brain can lead to HE.

What are the first signs of HE?

Actually, at first, people with HE may be unaware that they have it. Noticeable symptoms include forgetfulness and confusion, poor judgment, being extra nervous or excited, not knowing where you are or where you’re going, and inappropriate behavior or personality changes

What are the physical signs of HE?

They include breath with a musty or sweet odor, change in sleep patterns, worsening of handwriting, movements or shaking of hands or arms, slurred speech, and slowed or sluggish movement.

Are there different stages of HE?

Yes, HE has four distinct stages:

  • (1) Mild HE: Patients may have sleep problems, trouble concentrating, large mood swings and find it difficult to write.

  • (2) Moderate HE: Patients may lack energy, be forgetful, have problems with basic math, behave strangely and slur their speech. They may flap or shake their hands, and have difficulty balancing.

  • (3) Severe HE: Patients are sleepy and sometimes pass out. They can’t do basic math, they act strange, and they can be very fearful and jumpy.

  • (4) Final Stage: The final stage of HE is coma.

How is HE treated?

Treatment of HE may include diet and lifestyle changes, such as avoiding too much or too little protein, and an appropriate exercise regimen; Rifaximin (Xifaxan) to reduce bacteria in the intestines; Lactulose (type of sugar) to prevent the liver from absorbing toxins from the intestine; prevention and treatment of constipation, and medicine to treat infections.

What are some of the complications that may arise because of HE?

Complications may include brain swelling; permanent nervous system damage; sepsis (blood poisoning); and increased risk of heart, kidney or respiratory failure. In serious cases, hospitalization, coma, and even death can occur.

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Page updated: August 23rd, 2013