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Diagnosis of minimal hepatic encephalopathy: still a challenge
  1. Peter Ferenci
  1. Correspondence to Professor Peter Ferenci, Klein. Abteilung für Gastroenterologie und Hepatologie, Univ. Klinik für Innere Medizin III, Medizinische Universität Wien, Waehringer Guertel 18–20, Wien A 1090, Austria; peter.ferenci{at}

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Hepatic encephalopathy (HE) describes the spectrum of potentially reversible neuropsychiatric abnormalities seen in patients with liver dysfunction after exclusion of unrelated neurological and/or metabolic abnormalities. There is a continuum of changes in brain function from ‘normal’ to overt HE. Functionally impaired brain function with a deficit in intellectual performance, long-term memory and learning capability detected in asymptomatic patients by psychometric or electrophysiological tests is designed as ‘minimal HE’ (MHE).1 ,2 Several psychometric tests have been proposed to quantify the impairment of mental function in patients with mild stages of HE.3–5 Except for the number connection test most require costly equipment and are cumbersome to perform and are not used routinely in clinical practice. Since the distinction of MHE from HE grade 1 is difficult, the new guidelines commissioned by American Association for the Study of Liver Diseases and European Association for the Study of the Liver suggest a simpler classification …

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  • Correction notice This article has been corrected since it was published Online First. The title has been amended.

  • Competing interests None.

  • Provenance and peer review Commissioned; internally peer reviewed.

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