Editorial
Copyright ©2010 Baishideng. All rights reserved
World J Gastroenterol. Jul 21, 2010; 16(27): 3347-3357
Published online Jul 21, 2010. doi: 10.3748/wjg.v16.i27.3347
Changing face of hepatic encephalopathy: Role of inflammation and oxidative stress
Amit S Seyan, Robin D Hughes, Debbie L Shawcross
Amit S Seyan, Robin D Hughes, Debbie L Shawcross, Institute of Liver Studies, King’s College London School of Medicine at King’s College Hospital, King’s College Hospital, Denmark Hill, London, SE5 9RS, United Kingdom
Author contributions: Seyan AS wrote the article; Hughes RD and Shawcross DL edited the article.
Supported by A 5 year UK Department of Health HEFCE Clinical Senior Lectureship (to Dr. Shawcross DL)
Correspondence to: Dr. Debbie L Shawcross, Institute of Liver Studies, King’s College London School of Medicine at King’s College Hospital, King’s College Hospital, Denmark Hill, London, SE5 9RS, United Kingdom. debbie.shawcross@kcl.ac.uk
Telephone: +44-20-32993216 Fax: +44-20-32993167
Received: March 13, 2010
Revised: April 28, 2010
Accepted: May 5, 2010
Published online: July 21, 2010
Abstract

The face of hepatic encephalopathy (HE) is changing. This review explores how this neurocognitive disorder, which is associated with both acute and chronic liver injury, has grown to become a dynamic syndrome that spans a spectrum of neuropsychological impairment, from normal performance to coma. The central role of ammonia in the pathogenesis of HE remains incontrovertible. However, over the past 10 years, the HE community has begun to characterise the key roles of inflammation, infection, and oxidative/nitrosative stress in modulating the pathophysiological effects of ammonia on the astrocyte. This review explores the current thoughts and evidence base in this area and discusses the potential role of existing and novel therapies that might abrogate the oxidative and nitrosative stresses inflicted on the brain in patients with, or at risk of developing, HE.

Keywords: Hepatic encephalopathy; Ammonia; Inflammation; Oxidative stress; Astrocyte