Modern progress in hepatic encephalopathy

Abstract

Sir, We read with interest the article by Cash et al. 1 reviewing the pathophysiology and management of hepatic encephalopathy (HE). We agree that this condition is understudied and sub-optimally treated, but would suggest that the following points are considered. First, we would suggest that in contrast to the conclusions of the authors, recent research has provided invaluable insight into the cellular pathophysiology of HE. Modern magnetic resonance techniques have confirmed increased brain water content in patients with HE,2 highlighting the importance of the astrocyte-swelling hypothesis and other well-described pathophysiological mechanisms.3 While increased intra-astrocytic glutamine accumulation, driven by ambient …