Hepatic encephalopathy (HE)

Hepatic encephalopathy is a potentially life-threatening neuropsychiatric condition that occurs among patients with liver dysfunction. It remains underdiagnosed and under-treated, resulting in poor quality of life for patients and a high burden on those who care for them. It is a debilitating condition that affects up to 40% of patients across Europe who suffer from advanced chronic liver disease. Despite the severity of hepatic encephalopathy, it remains underdiagnosed and under-treated, resulting in poor quality of life for patients and their carers.


HE is characterized by a loss of brain function, resulting in mild to severe incapacity, and is sometimes subtle and difficult to notice. HE occurs when the liver doesn’t remove sufficient toxins from the blood and is estimated to affect up to 200,000 people in Europe.

Symptoms and signs of hepatic encephalopathy may include:

  • difficulty thinking
  • personality changes
  • poor concentration
  • problems with handwriting or loss of other small hand movements
  • confusion
  • forgetfulness
  • poor judgment
  • a musty or sweet breath odor
  • confusion
  • drowsiness or lethargy
  • anxiety
  • seizures
  • severe personality changes
  • fatigue
  • confused speech
  • shaky hands
  • slow movements


Hepatic Encephalopathy (HE) still on top of ELPA’s agenda

The second ELPA Educational Training day on June 24, 2020 was the occasion to reflect again on Hepatic Encephalopathy thanks to Dr. Teresa Casanovas Taltavull’s presentation about optimising outcomes in patients with hepatic encephalopathy (HE), a complication of cirrhosis. She also started her session quoting the article ‘Hepatic encephalopathy: a call to action to optimize patient outcomes’ from 2016 about HE campaign written by an ELPA representative.

Hepatic encephalopathy (HE) is a reversible syndrome of impaired brain function occurring in patients with advanced liver diseases. ELPA, being conscious of the importance of this topic, has never stopped putting it in the core of its policy and scientific activities.

On 26th February 2019, for example, the European Liver Patients’ Association (ELPA) held a policy roundtable entitled ‘The burden of Liver disease in Europe: The case of Hepatic Encephalopathy’ in the European Parliament. The event, co-hosted by some Members of the European Parliament (MEPs), brought together policymaker and high-level EU stakeholders in liver disease as well as related fields such as brain.

The reference document for the roundtable was ELPA’s new policy white paper focused on the key challenges facing people with hepatic encephalopathy (HE) in Europe and the policy actions which are required to secure a better future for people with hepatic encephalopathy (HE).

At the end of the meeting, there was broad support for the policy recommendations outlined in the new policy white paper and a commitment to pursue these recommendations in the 2019-2024 mandate.

ELPA’s engagement on HE will not end!


Reduction of plasma ammonia remains the central therapeutic strategy for HE, but there is a need for newer novel therapies. The two most often used medicines to treat HE are lactulose and certain antibiotics.

If you are, or a person that you know is, suffering from the symptoms described above and are/is, contact your doctor or a liver patient organization in your country. European Liver Patients’ Association is an umbrella organization with the national patient organizations as members. List of our members can be found here.

Hepatic encephalopathy A call to action to optm pat outcomes [PDF]