Hepatic encephalopathy is a major and burdensome complication of cirrhosis, with significant consequences for patients, families, and healthcare systems. Its progression from covert to overt disease is not fully reflected in current transplant listing criteria, leaving many patients inadequately prioritized for transplantation despite substantial impairment in quality of life. This guideline of the American College of Gastroenterology presents 24 recommendations for the diagnosis, management, and prevention strategies for hepatic encephalopathy. The Grading of Recommendations, Assessment, Development, and Evaluation process was used to assess the quality of evidence for each statement. Key concepts are also provided for statements to which the Grading of Recommendations, Assessment, Development, and Evaluation process has not been applied.
