Recent Perception About Hepatic Encephalopathy: A Review Article

SUMMARY Background Hepatic encephalopathy (HE) has been defined as an adverse neurological consequence of hepatic decompensation. Hepatic encephalopathy can contribute to high fatality rate, and it has undesirable impact on different aspects of quality of life (QOL). Globally, HE has a high-ranking epidemiology. Therefore, it is a standpoint that requires extra research. the precise molecular mechanism of HE is still controversial. Hyperammonemia is regarded to be the most appropriate theory explaining the occurrence of HE until now is ammonia theory and this proposal reversed on the management approach and henceforth the outcomes. Aim This review aimed at giving a summary about HE with focusing on the new insight in HE pathophysiology and the pharmacological and non-pharmacological strategies. Method From December 2016 to March 2021, we conducted the study using various research engine such as Medline and PubMed. Different research terms as ‘Hepatic encephalopathy, Ammonia, Inflammation’ were used. All identified papers were full-text, and English-language papers. We also searched the reference lists of selected articles for additional related ones. Results The study revealed that there is an influential relationship between increasing ammonia level and existence of inflammation. Furthermore, the study convinced the synergism between hyperammonemia and inflammation in the pathogenesis of HE. Therefore, Agents with both ammonia decreasing effect and anti-inflammatory properties are superior to antibiotics in managing of HE. Conclusion Reversing inflammation is beneficial to maintain the blood brain barrier integrity and prevent the entry of toxic mediators into the brain. New targets should be established, and a combination of anti-inflammatory agent and ammonia-lowering agent should be used as first line therapy in the management of HE