Hepatic encephalopathy (HE) is a neurologic complication of advanced liver disease, causing impaired functioning, reduced quality of life (QOL), and increased hospitalisation and mortality. This review discusses HE burden, precipitating risk factors, and strategies to reduce overt HE (OHE) recurrence. Key precipitants include medications, constipation, dehydration, uncontrolled diabetes, electrolyte imbalances, GI bleeding, infection, and sarcopenia. Management involves education, nutritional support, pharmacotherapy, and nonpharmacologic interventions (shunt embolisation, transplantation). Guidelines recommend lactulose as secondary prophylaxis; rifaximin is added when further episodes occur. PEG and LOLA may have roles in certain patients. Investigational approaches include nitazoxanide, FMT, and AI‑based technologies.

A team led by the University of Pittsburgh’s Jeremy Levy and Chandralekha Singh describes a seminar format designed to recover some of the hidden knowledge and decisions that result in polished papers.

Black, mixed-race, Asian, and Indigenous women with lower levels of education face greater difficulties. The study followed the same group for a decade.