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This review focuses on the current understanding of how alcohol affects the brain in cirrhosis patients with and without hepatic encephalopathy (HE). Chronic alcohol use is associated with nutritional deficiencies, dementia, cirrhosis, and decompensating events such as HE. Direct toxicity on brain tissue, induction of neuro\u2010inflammation, and alcohol's alterations of the gut microbiome are possible mechanisms for the clinical features of HE associated with alcohol use. Acute management of the alcoholic cirrhosis patient with altered mental status should focus on ruling out other causes, best intensive care, and use of gut\u2010based therapies such as lactulose and rifaximin. Long\u2010term management centers on optimizing treatment of concurrent mood disorders, nutritional support, and medical management of complications associated with cirrhosis. Future studies are needed to clarify mechanisms of brain injury in concomitant alcohol misuse and HE in addition to designing treatment interventions in order to improve outcomes in these patients.<\/jats:p>","DOI":"10.1111\/acer.13605","type":"journal-article","created":{"date-parts":[[2018,2,8]],"date-time":"2018-02-08T01:52:44Z","timestamp":1518054764000},"page":"660-667","source":"Crossref","is-referenced-by-count":41,"title":["Effects of Alcohol on the Brain in Cirrhosis: Beyond Hepatic Encephalopathy"],"prefix":"10.1111","volume":"42","author":[{"given":"Brian C.","family":"Davis","sequence":"first","affiliation":[{"name":"Division of Gastroenterology, Hepatology and Nutrition Virginia Commonwealth University and McGuire VA Medical Center (BCD, JSB) Richmond Virginia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4928-3681","authenticated-orcid":false,"given":"Jasmohan 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