Review ArticleDefinition and Nomenclature of Hepatic Encephalopathy
Section snippets
Clinical impact
The neuropsychiatric impairment associated with HE can range from subtle, mild alteration of cognition and consciousness to coma, to severe neurodegeneration depending on the stage of the illness. In general, the neuropsychiatric impairments associated with HE are largely reversible. However, complete regeneration and restoration of the brain functions may not be possible in the extreme cases of severe hepatocerebral degeneration.
HE is one of the most debilitating manifestations of liver
Nomenclature & classification
Until fairly recently, there had been no consensus on the diagnostic criteria and thus existed a great deal of confusions regarding the nomenclature and classification of HE. Much of this was resolved after the first consensus conference in this regard held during the 11th World Congress of Gastroenterology in Vienna in 1998 which published its consensus multiaxial definition and classification of HE in 2002.2, 3 Despite this, the topic of classification and nomenclature of HE continued to
Nomenclature updates in the 2014 American Association for the Study of Liver Diseases/European Association for the Study of the Liver guidelines: The four axes
Very recently, AASLD and EASL have come up with joint guideline for the management of HE in chronic liver disease. Following review of the current evidence and reassessment of existing classifications, the task force recommends that HE should be classified based on the underlying etiology, severity of clinical manifestations, time course and whether or not a precipitating factor is identified (Table 2).1
It should be noted that this nomenclature system primarily pertains to HE associated with
Summary
In summary, the nomenclature and classification of hepatic encephalopathy continues to evolve as our understanding of this complex neuropsychiatric process advances. For practical purposes, HE should be categorized based on the underlying etiology, clinical severity, time course and precipitating factors as recommended by the recent AASLD-EASL guidelines. This four axis descriptive classification system is expected to improve description and categorization of the diagnosis, bring more
Conflicts of interest
All authors have none to declare.
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