title: Hepatic encephalopathy: from pathophysiology to therapeutic management.
abstract: Hepatic encephalopathy is a complex and potentially reversible neuropsychiatric syndrome complicating acute or chronic liver disease. Clinical manifestations are multiple and varied, ranging from minimal neurological changes to coma. Ammonia is the main toxic substance involved in the pathogenesis of hepatic encephalopathy, although other mechanisms, such as modifications of the blood-brain barrier, disruptions in neurotransmission and abnormalities in GABAergic and benzodiazepine pathways may also play a role. The identification and treatment of precipitating factors is crucial in the management of patients with hepatic encephalopathy. Current treatments are based on reducing intestinal ammonia load by agents such as antibiotics or disaccharides, although their efficacy is yet to be clearly established.
authors.affiliation: Hôpital Saint Eloi, Montpellier, France.
authors.forename: Michael
authors.initials: M
authors.lastname: Bismuth
authors.forename: Natalie
authors.initials: N
authors.lastname: Funakoshi
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Cadranel
authors.forename: Pierre
authors.initials: P
authors.lastname: Blanc
mesh_terms: D000641:Ammonia / Q000378:metabolism; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001569:Benzodiazepines / Q000378:metabolism; D001812:Blood-Brain Barrier / Q000378:metabolism / Q000503:physiopathology; D002540:Cerebral Cortex / Q000187:drug effects / Q000378:metabolism / Q000503:physiopathology; D004187:Disaccharides / Q000627:therapeutic use; D004734:Energy Metabolism; D005260:Female; D018682:GABA Agents / Q000378:metabolism; D016481:Helicobacter Infections / Q000188:drug therapy; D006501:Hepatic Encephalopathy / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology*; D006801:Humans; D007413:Intestinal Mucosa / Q000378:metabolism; D007422:Intestines / Q000382:microbiology / Q000503:physiopathology; D008297:Male
chemical_list: D000900:Anti-Bacterial Agents; D004187:Disaccharides; D018682:GABA Agents; D001569:Benzodiazepines; D000641:Ammonia