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Purpose of Review: The burden of malnutrition is high in patients with cirrhosis, especially in those with hepatic encephalopathy (HE). This has a bearing on increased morbidity and mortality. Heightened attention needs to be paid to screen the patients at high nutritional risk both in the outpatient and hospitalized settings. This review summarizes the current evidence for nutritional support in HE patients and compares the recommendations about nutritional requirement as laid out by various organizations. Recent Findings: On survey of the literature, there is a consensus on avoiding protein restriction of the diets in HE patients along with uniform recommendations on caloric requirements. An exciting field of manipulating the gut microbiome in nutritional sciences may hold promise as well as there may be a future role for branched chain amino acids in nutritional management of HE patients. Summary: Even though the data suggest that nutritional improvement lead to better outcomes including lower readmission rates in cirrhosis, operationalizing these into practice remains a challenge. To achieve this, a multi-disciplinary approach with nutritional education of the frontline care providers, earlier nutritional risk screening of patients, involvement of the nutrition professionals as part of the team, and repeated dietary counseling for the patient and caregiver/s is required. Ultimately, this may need more focus, resource allocation, and uniform guidelines across all countries to make this a success. [ABSTRACT FROM AUTHOR]

Overt hepatic encephalopathy (OHE) and covert hepatic encephalopathy (CHE) are two clinically distinct entities that are at the end of the spectrum of cognitive impairment due to portal hypertension. They are fraught with diagnostic and treatment challenges, but both could result in serious complications if not intervened upon in a timely fashion. CHE has been recognized as a harbinger to OHE providing an opportunity to intervene. There are numerous diagnostic strategies for CHE, and most require specialized equipment, trained personnel, and time. Diagnosis of OHE is significantly easier compared to CHE. As such, the psychometric tests have been more favored due to less dependence on specialized equipment and personnel, and their ability to be equally reliable compared to neuropsychological tests. While we have learned more about the pathophysiology of hepatic encephalopathy, our treatment modalities have not evolved as much. A collaborative approach to management, with development of easier reliable tests, will help us combat this epidemic. [ABSTRACT FROM AUTHOR]