Dietary approach and gut microbiota modulation for chronic hepatic encephalopathy in cirrhosis

Figure 1 Multifactorial pathogenesis of hepatic encephalopathy. The figure summarizes the pathogenetic mechanisms at all levels of the gut-liver-brain axis underlying the development of hepatic encephalopathy. In this context, the interplay between systemic inflammation and hyperammonemia plays a central role (see text for details). CNS: Central nervous system; GABA: Gamma-aminobutyric acid; GI: Gastrointestinal; IL: Interleukin; NH₄: Ammonia; NO: Nitric oxide; PAMPs: Pathogen associated molecular patterns; ROS: Reactive oxygen species; SIBO: Small intestine bacterial overgrowth; SIRS: Systemic inflammatory response syndrome; TNF-α: Tumor necrosis factor-alpha.