Review Article
Definition and Nomenclature of Hepatic Encephalopathy

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Hepatic encephalopathy (HE) can manifest with a broad range of neuropsychiatric abnormalities of varying severity, acuity and time course with significant clinical implications. Lack of precise nomenclature and classification had hampered research in this complex clinical problem. A multiaxial classification system based on underlying etiology, clinical severity, time course and presence or absence of precipitating factors has been developed over the recent years and has been fully incorporated in the newly published AASLD-EASL guidelines on HE management. This multiaxial classification is expected to bring uniformity in describing and categorizing of HE across centers and nations, foster clinical research and improve patient care and outcome.

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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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