National Center for Advancing and Translational Sciences Genetic and Rare Diseases Information Center, a program of the National Center for Advancing and Translational Sciences

Hepatic encephalopathy


Other Names:
Hepatoencephalopathy; Encephalopathy, hepatic
Categories:
Hepatic encephalopathy is a syndrome observed in some patients with cirrhosis. It is defined as a spectrum of neuropsychiatric abnormalities in patients with liver dysfunction, when other known brain disease has been excluded.[1] Signs and symptoms may be debilitating, and they can begin mildly and gradually, or occur suddenly and severely.[2] They may include personality or mood changes, intellectual impairment, abnormal movements, a depressed level of consciousness, and other symptoms.[1][2] There are several theories regarding the exact cause, but development of the condition is probably at least partially due to the effect of substances that are toxic to nerve tissue (neurotoxic), which are typically present with liver damage and/or liver disease. Treatment depends upon the severity of mental status changes and upon the certainty of the diagnosis.[1]
Last updated: 6/22/2016
Hepatic encephalopathy is not an inherited condition, so an individual who has it cannot pass it on to his/her children. It is brought on by chronic liver failure, particularly in alcoholics with cirrhosis.[3]

Although there are many theories and possibilities regarding what exactly causes hepatic encephalopathy, it is thought that one of the main causes is the accumulation of ammonia in the blood, which the liver, damaged by alcoholic liver disease, cannot remove. Researchers have found that ammonia alters the expression of certain genes; the genes that may be affected carry instructions for brain proteins.[3] When the instructions in these genes are not "followed" correctly by the body due to the altered expression of the genes, the cells in the brain can no longer function normally, which may contribute to the signs and symptoms of the disease. However, the genes themselves are not changed in such a way that these changes are passed down to an individual's children.
Last updated: 6/22/2016

FDA-Approved Treatments

The medication(s) listed below have been approved by the Food and Drug Administration (FDA) as orphan products for treatment of this condition. Learn more orphan products.

  • Rifaximin (Brand name: Normix) - Manufactured by Salix Pharmaceuticals, Inc.
    FDA-approved indication: Reduction in the risk of overt hepatic encephalopathy (HE) recurrence in patients greater than or equal to 18 years of age.
    National Library of Medicine Drug Information Portal

Research helps us better understand diseases and can lead to advances in diagnosis and treatment. This section provides resources to help you learn about medical research and ways to get involved.

Clinical Research Resources

  • ClinicalTrials.gov lists trials that are related to Hepatic encephalopathy. Click on the link to go to ClinicalTrials.gov to read descriptions of these studies.

    Please note: Studies listed on the ClinicalTrials.gov website are listed for informational purposes only; being listed does not reflect an endorsement by GARD or the NIH. We strongly recommend that you talk with a trusted healthcare provider before choosing to participate in any clinical study.
  • International Society for Hepatic Encephalopathy and Nitrogen Metabolism (ISHEN) is a non-profit organization aimed at promoting scientific and clinical research on nitrogen metabolism and brain disorders associated with liver disease.

Support and advocacy groups can help you connect with other patients and families, and they can provide valuable services. Many develop patient-centered information and are the driving force behind research for better treatments and possible cures. They can direct you to research, resources, and services. Many organizations also have experts who serve as medical advisors or provide lists of doctors/clinics. Visit the group’s website or contact them to learn about the services they offer. Inclusion on this list is not an endorsement by GARD.

Organizations Supporting this Disease

  • The Hepatitis C Support Project (HCSP) is a registered non-profit organization founded to address the lack of education, support, and services available at that time for the HCV population. HCSP's mission is to provide unbiased information, support, and advocacy to all communities affected by HCV and HIV/HCV coinfection, including medical providers. To see their Fact Sheet about hepatic encephalopathy, click here.

Organizations Providing General Support

These resources provide more information about this condition or associated symptoms. The in-depth resources contain medical and scientific language that may be hard to understand. You may want to review these resources with a medical professional.

Where to Start

  • The Department of Veterans Affairs posts information discussed during a talk on hepatic encephalopathy given at the 2004 Advanced Liver Disease Training Program held in Manhattan, New York, from April 12 to 14, and sponsored by the VA Hepatitis C Resource Center Program and Hepatitis C Program Office. To view the presentation, click on the link.
  • MedlinePlus was designed by the National Library of Medicine to help you research your health questions, and it provides more information about this topic.
  • The Merck Manuals Online Medical Library provides information on this condition for patients and caregivers. 
  • The National Institute on Alcohol Abuse and Alcoholism (NIAAA) conducts research focused on improving the treatment and prevention of alcoholism and alcohol-related problems to reduce the enormous health, social, and economic consequences of this disease. Click on the link to view information on this topic. 
  • The National Organization for Rare Disorders (NORD) has a report for patients and families about this condition. NORD is a patient advocacy organization for individuals with rare diseases and the organizations that serve them.

In-Depth Information

  • Medscape Reference provides information on this topic. You may need to register to view the medical textbook, but registration is free.
  • The Monarch Initiative brings together data about this condition from humans and other species to help physicians and biomedical researchers. Monarch’s tools are designed to make it easier to compare the signs and symptoms (phenotypes) of different diseases and discover common features. This initiative is a collaboration between several academic institutions across the world and is funded by the National Institutes of Health. Visit the website to explore the biology of this condition.
  • PubMed is a searchable database of medical literature and lists journal articles that discuss Hepatic encephalopathy. Click on the link to view a sample search on this topic.

Questions sent to GARD may be posted here if the information could be helpful to others. We remove all identifying information when posting a question to protect your privacy. If you do not want your question posted, please let us know. Submit a new question

  • How was hepatic encephalopathy discovered, and who first described it? Is there a chance of passing this condition along to my children? See answer


  1. David C Wolf. Hepatic Encephalopathy. Medscape Reference. December 8, 2015; http://emedicine.medscape.com/article/186101-overview.
  2. Subodh K. Lal. Loss of brain function - liver disease. MedlinePlus. August 14, 2015; http://www.nlm.nih.gov/medlineplus/ency/article/000302.htm.
  3. Roger F. Butterworth. Hepatic Encephalopathy. National Institute on Alcohol Abuse and Alcoholism (NIAAA). September 29, 2004; http://pubs.niaaa.nih.gov/publications/arh27-3/240-246.htm.