Patients with chronic liver disease (CLD) can develop hepatic encephalopathy that is not yet clinically overt. When brain dysfunction is detectable only on testing or by subtle clinical signs — with no disorientation and no asterixis — the condition is classified as minimal hepatic encephalopathy (MHE) or covert hepatic encephalopathy (CHE). This presentation requires a different management calculus than overt HE.
A patient with chronic liver disease shows signs of brain dysfunction on formal testing or clinical assessment, but is not disoriented and does not display asterixis — meeting the definition of minimal or covert hepatic encephalopathy.
Routine treatment is not recommended across the board in MHE and CHE; the protocol specifies the circumstances under which individual clinical judgment may support use of a therapy from the overt HE armamentarium — and what that selection process should look like.
DOI: 10.1002/hep.27210
Minimal hepatic encephalopathy and CHE is defined as the presence of test-dependent or clinical signs of brain dysfunction in patients with CLD who are not disoriented or display asterixis.
Because of the multiple methods used to define MHE and CHE, varying endpoints, short-term treatment trials, and differing agents used in trials to date, routine treatment for MHE is not recommended at this stage.
Exceptions could be made on a case-by-case basis using treatments that are approved for OHE, particularly for patients with CHE and West Haven Grade I HE.
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