Hepatic Encephalopathy (HE)

What is Hepatic Encephalopathy (HE)?

Hepatic encephalopathy (HE) refers to the changes in the brain that occur in patients with
advanced, acute or chronic liver disease and is one of the major complications of cirrhosis. It
can occur suddenly in people with acute liver failure but is more often seen in those with
chronic liver disease.
How does HE develop?
One of the things your liver does is to change harmful substances in the body to make them
harmless. However if the liver is unable to fully function these toxins can build up in the
bloodstream. HE occurs when the liver cannot remove certain toxins and chemicals such as
ammonia from the blood. These then enter the brain and can cause both physical and mental
changes such as HE. Certain factors can trigger an episode of HE in liver patients see our
publication for full details.
What are the symptoms?
HE symptoms can range from mild to severe and can vary from person to person. Symptoms
can develop rapidly or slowly over a period of time. Patients with HE can have both physical
symptoms and reduced mental function.
Mild symptoms may include:

mild confusion

forgetfulness

personality or mood changes

stale or sweet odour on the breath

poor judgement

poor concentration

change in sleep patterns

worsening of handwriting or small hand movements

Severe symptoms may include:

unusual movements or shaking of hands or arms

extreme anxiety

seizures

severe confusion

sleepiness or fatigue

severe personality changes

jumbled and slurred speech

slow movement

HE can be an emergency so it is important to seek advice from your doctor as soon as your
symptoms begin. If you have already been diagnosed with HE and you feel like your
condition is worsening then seek medical help as soon as possible.
Treatment
HE is a treatable condition however the severity of the condition and any causes of the
episode will determine the treatment that a person will be given.
The first step will be to identify and then treat any factors that have caused the HE episode.
Then, once this has been treated the doctor may prescribe medication to help prevent future
episodes. The long term aim of HE treatment is to reduce the production and absorption of
toxins such as ammonia.
There are three types of medication usually used to reduce recurring episodes of HE:
Lactulose a type of sugar that changes the acidity of your stools to help prevent the growth
of some bacteria which produce ammonia in the bowel.
Neomycin a type of antibiotic which may be used to help reduce the production of
ammonia by killing instestinal bacteria in the gut.
Rifaximin a specific type of this antibiotic is used to stop the growth of certain bacteria in
the gut and is usally taken alongside other treatments such as lactulose.
As with all medicines these need to be taken in a certain way and can have side effects.
Please see our publication for full information.
Certain medications such as those containing ammonium and those broken down by the liver
such as sedatives and tranquilisers should be avoided.
Looking after yourself
Eating a healthy balanced diet and exercising to maintain a healthy weight are recommended.
Patients with severe repeated cases of HE may be advised to reduce the amount of protein in
their diet but it is important that this is only done on medical advice as a lack of protein can
cause malnutrition.

Alcohol and smoking are dangerous to anyone with liver problems.

For more detailed information download the publication below.
Support
Please visit the support section of our website for information on Support groups in your area.

Download publication: Hepatic Encephalopathy HE0114

BMA Patient Information Awards 2015 Commended

To view references: click here

Last Reviewed March 2014
Reviewed by: Dr Richard Aspinall, Consultant Hepatologist, Department of
Gastroenterology and Hepatology, Queen Alexandra Hospital, Portsmouth.

To view the preliminary results from a Norgine survey on HE click here

Time to DeLiver report on HE which contains ten calls to action to improve the
identification, treatment and management of hepatic encephalopathy;