Hepatic encephalopathy (HE) is a potentially reversible condition characterized by a spectrum of neurological or psychiatric abnormalities ranging from subclinical alterations to coma, which occurs as one of the many complications of decompensated liver disease or portosystemic shunting [1]. About 30 to 45% of patients with cirrhosis develop overt hepatic encephalopathy [2], which is associated with significant morbidity, mortality, high healthcare cost, and a huge burden on patients and their caregivers [3, 4].

The pathophysiology of HE is poorly understood, it is often multifactorial, and different abnormalities may be present at the same time, leading to the development of HE [5].

The various pathogenetic mechanisms proposed in the development of HE are [5, 6]:

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