Ashwin W, Deva R, Girish C. Paradigm shifts in hepatic encephalopathy: Review of recent therapeutic breakthroughs. World J Meta-Anal 2025; 13(3): 108018 [DOI: 10.13105/wjma.v13.i3.108018]
Corresponding Author of This Article
Chandrashekaran Girish, PhD, Additional Professor, Department of Pharmacology, Jawaharlal Institute of Postgraduate Medical Education and Research, JIPMER Campus Road, Gorimedu, Puducherry 605006, India. gcnx@rediffmail.com
Research Domain of This Article
Medicine, Research & Experimental
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Meta-Anal. Sep 18, 2025; 13(3): 108018 Published online Sep 18, 2025. doi: 10.13105/wjma.v13.i3.108018
Paradigm shifts in hepatic encephalopathy: Review of recent therapeutic breakthroughs
Wilfred Ashwin, Reka Deva, Chandrashekaran Girish
Wilfred Ashwin, Reka Deva, Chandrashekaran Girish, Department of Pharmacology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry 605006, India
Author contributions: Ashwin W contributed to data collection and manuscript writing; Deva R contributed to manuscript preparation and editing; Girish C contributed to idea generation, proof checking, and manuscript editing.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Chandrashekaran Girish, PhD, Additional Professor, Department of Pharmacology, Jawaharlal Institute of Postgraduate Medical Education and Research, JIPMER Campus Road, Gorimedu, Puducherry 605006, India. gcnx@rediffmail.com
Received: April 7, 2025 Revised: June 16, 2025 Accepted: August 12, 2025 Published online: September 18, 2025 Processing time: 160 Days and 4.5 Hours
Abstract
Hepatic encephalopathy (HE) remains a significant neuropsychiatric complication of liver disease, characterized by a spectrum of cognitive, behavioral, and motor impairments. Recent advances in the understanding of its pathophysiology have identified inflammation and gut-liver-brain axis interactions along with conventional theories on ammonia toxicity. Rifaximin and lactulose continue to be the first-line therapies. However, novel approaches like ammonia-lowering agents such as glycerol phenylbutyrate, ornithine phenylacetate, zinc and L-ornithine L-aspartate, gut microbiota modulation by probiotics, fecal microbiota transplantation, and anti-inflammatory drugs like rifamycin and its analogs started showing promising results in clinical trials. This review emphasizes the importance of a multidisciplinary approach in HE management, combining traditional and innovative therapies to enhance the patient’s quality of life and to reduce the healthcare burdens and also highlights the newer treatment strategies for future research and clinical application.
Core Tip: The review article explores the current approach of using the past and recent articles and studies found and highlighted with the use of Medical Subject Headings terminologies in platforms such as PubMed Central, Google Scholar, Scopus, Web of Science, and Research Gate.
