Higher prevalence and severity of hepatic encephalopathy in patients with HCV cirrhosis and diabetes mellitus: is presence of autonomic neuropathy the missing part of the puzzle?

Hepatic encephalopathy (HE) is a complex and variable neuropsychiatric syndrome that is seen in patients with acute and chronic liver diseases. The presence or severity of HE does not always show a strong and consistent relationship with the severity of liver disease or portal hypertension suggesting that other predisposing or precipitating factors may be involved. In this issue of the journal, it has been suggested that DM may contribute to the presence and severity of HE independent of the severity of liver disease in patients with HCV cirrhosis. This editorial examines the limitations of the study and potential mechanisms that could explain the relationship between DM with HE including the role of autonomic neuropathy.