{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T10:42:46Z","timestamp":1790073766782,"version":"4.0.1"},"reference-count":112,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2023,2,2]],"date-time":"2023-02-02T00:00:00Z","timestamp":1675296000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Hepatic encephalopathy (HE) is a common complication in patients with advanced liver disease. It is a brain dysfunction characterized by neurological and psychiatric symptoms that significantly affects quality of life, morbidity and mortality of patients. HE has various precipitants that can potentially promote its onset, alone or in combination. Among the historically well-known precipitants, such as infections, gastrointestinal bleeding, dehydration, electrolyte disorders and constipation, recent studies have highlighted the role of malnutrition and portosystemic shunts as new precipitating factors of HE. The identification, management and correction of these factors are fundamental for effective HE treatment, in addition to pharmacological therapy with non-absorbable disaccharides and\/or antibiotics.<\/jats:p>","DOI":"10.3390\/jcm12031187","type":"journal-article","created":{"date-parts":[[2023,2,2]],"date-time":"2023-02-02T05:44:45Z","timestamp":1675316685000},"page":"1187","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":23,"title":["Old and New Precipitants in Hepatic Encephalopathy: A New Look at a Field in Continuous Evolution"],"prefix":"10.3390","volume":"12","author":[{"given":"Daniele","family":"Bellafante","sequence":"first","affiliation":[{"name":"Department of Translational and Precision Medicine, Sapienza University of Rome, 00185 Roma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefania","family":"Gioia","sequence":"additional","affiliation":[{"name":"Department of Translational and Precision Medicine, Sapienza University of Rome, 00185 Roma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6960-9701","authenticated-orcid":false,"given":"Jessica","family":"Faccioli","sequence":"additional","affiliation":[{"name":"Department of Translational and Precision Medicine, Sapienza University of Rome, 00185 Roma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oliviero","family":"Riggio","sequence":"additional","affiliation":[{"name":"Department of Translational and Precision Medicine, Sapienza University of Rome, 00185 Roma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8596-2609","authenticated-orcid":false,"given":"Lorenzo","family":"Ridola","sequence":"additional","affiliation":[{"name":"Department of Translational and Precision Medicine, Sapienza University of Rome, 00185 Roma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7038-9539","authenticated-orcid":false,"given":"Silvia","family":"Nardelli","sequence":"additional","affiliation":[{"name":"Department of Translational and Precision Medicine, Sapienza University of Rome, 00185 Roma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,2,2]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"715","DOI":"10.1002\/hep.27210","article-title":"Hepatic encephalopathy in chronic liver disease: 2014 Practice Guideline by the American Association for the Study of Liver Diseases and the European Association for the Study of the Liver","volume":"60","author":"Vilstrup","year":"2014","journal-title":"Hepatology"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"190","DOI":"10.1016\/j.dld.2018.11.035","article-title":"Hepatic encephalopathy 2018: A clinical practice guideline by the Italian Association for the Study of the Liver (AISF)","volume":"51","author":"Montagnese","year":"2019","journal-title":"Dig. Liver Dis."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"European Association for the Study of the Liver (2022). EASL Clinical Practice Guidelines on the management of hepatic encephalopathy. J. Hepatol., 77, 807\u2013824.","DOI":"10.1016\/j.jhep.2022.06.001"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1016\/j.cld.2020.01.001","article-title":"Epidemiology of Hepatic Encephalopathy","volume":"24","author":"Elsaid","year":"2020","journal-title":"Clin. Liver Dis."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1111\/j.1746-6342.2006.03215.x","article-title":"Review article: The burden of hepatic encephalopathy","volume":"25","author":"Poordad","year":"2007","journal-title":"Aliment. PharmacolTher."},{"key":"ref_6","first-page":"151","article-title":"The burden of minimal hepatic encephalopathy: From diagnosis to therapeutic strategies","volume":"31","author":"Ridola","year":"2018","journal-title":"Ann. Gastroenterol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"578","DOI":"10.1007\/BF02282344","article-title":"Hepatic encephalopathy after transjugular intrahepatic portosystemic shunt. Incidence and risk factors","volume":"41","author":"Riggio","year":"1996","journal-title":"Dig. Dis. Sci."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1526","DOI":"10.1016\/j.jhep.2020.07.013","article-title":"Hepatic encephalopathy: Novel insights into classification, pathophysiology and therapy","volume":"73","author":"Rose","year":"2020","journal-title":"J. Hepatol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"193","DOI":"10.2147\/CEG.S160921","article-title":"A model of blood-ammonia homeostasis based on a quantitative analysis of nitrogen metabolism in the multiple organs involved in the production, catabolism, and excretion of ammonia in humans","volume":"11","author":"Levitt","year":"2018","journal-title":"Clin. Exp. Gastroenterol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1111\/j.1478-3231.2010.02302.x","article-title":"Interorgan ammonia metabolism in liver failure: The basis of current and future therapies","volume":"31","author":"Wright","year":"2011","journal-title":"Liver Int."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1007\/s11011-008-9112-7","article-title":"Identifying the direct effects of ammonia on the brain","volume":"24","author":"Bosoi","year":"2009","journal-title":"Metab. Brain Dis."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"640","DOI":"10.1016\/j.jhep.2010.07.045","article-title":"Infection and systemic inflammation, not ammonia, are associated with Grade 3\/4 hepatic encephalopathy, but not mortality in cirrhosis","volume":"54","author":"Shawcross","year":"2011","journal-title":"J. Hepatol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1016\/j.jceh.2012.08.004","article-title":"Gut microbiota, inflammation and hepatic encephalopathy: A puzzle with a solution in sight","volume":"2","author":"Dhiman","year":"2012","journal-title":"J. Clin. Exp. Hepatol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"3347","DOI":"10.3748\/wjg.v16.i27.3347","article-title":"Changing face of hepatic encephalopathy: Role of inflammation and oxidative stress","volume":"16","author":"Seyan","year":"2010","journal-title":"World J. Gastroenterol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"G168","DOI":"10.1152\/ajpgi.00190.2011","article-title":"Linkage of gut microbiome with cognition in hepatic encephalopathy","volume":"302","author":"Bajaj","year":"2012","journal-title":"Am. J. Physiol. Gastrointest. Liver Physiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"637","DOI":"10.3390\/nu3060637","article-title":"Gut microbiota and inflammation","volume":"3","author":"Hakansson","year":"2011","journal-title":"Nutrients"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Hassouneh, R., and Bajaj, J.S. (2021). Gut Microbiota Modulation and Fecal Transplantation: An Overview on Innovative Strategies for Hepatic Encephalopathy Treatment. J. Clin. Med., 10.","DOI":"10.3390\/jcm10020330"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1055\/s-0032-1301737","article-title":"Infectious complications of acute and chronic liver disease","volume":"33","author":"Leber","year":"2012","journal-title":"Semin. Respir. Crit. Care Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1310","DOI":"10.1016\/j.jhep.2014.01.024","article-title":"Bacterial infections in cirrhosis: A position statement based on the EASL Special Conference 2013","volume":"60","author":"Jalan","year":"2014","journal-title":"J. Hepatol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"437","DOI":"10.3350\/cmh.2020.0329","article-title":"Changes in the epidemiology and management of bacterial infections in cirrhosis","volume":"27","author":"Piano","year":"2021","journal-title":"Clin. Mol. Hepatol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1385","DOI":"10.1016\/j.jhep.2014.08.010","article-title":"Cirrhosis-associated immune dysfunction: Distinctive features and clinical relevance","volume":"61","author":"Albillos","year":"2014","journal-title":"J. Hepatol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1016\/j.jhep.2013.07.044","article-title":"Pathological bacterial translocation in liver cirrhosis","volume":"60","author":"Wiest","year":"2014","journal-title":"J. Hepatol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"940","DOI":"10.1016\/j.jhep.2013.12.019","article-title":"Altered profile of human gut microbiome is associated with cirrhosis and its complications","volume":"60","author":"Bajaj","year":"2014","journal-title":"J. Hepatol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"398","DOI":"10.1016\/j.jhep.2018.10.027","article-title":"European Foundation for the Study of Chronic Liver Failure (EF-Clif). Multidrug-resistant bacterial infections in patients with decompensated cirrhosis and with acute-on-chronic liver failure in Europe","volume":"70","author":"Prado","year":"2019","journal-title":"J. Hepatol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1368","DOI":"10.1053\/j.gastro.2018.12.005","article-title":"International Club of Ascites Global Study Group. Epidemiology and Effects of Bacterial Infections in Patients With Cirrhosis Worldwide","volume":"156","author":"Piano","year":"2019","journal-title":"Gastroenterology"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1551","DOI":"10.1002\/hep.25532","article-title":"Prevalence and risk factors of infections by multiresistantbacteria in cirrhosis: A prospective study","volume":"55","author":"Acevedo","year":"2012","journal-title":"Hepatology."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"979","DOI":"10.1016\/j.cgh.2010.06.024","article-title":"Cirrhoticpatients are at risk for health care-associated bacterial infections","volume":"8","author":"Merli","year":"2010","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1016\/j.jhep.2013.03.012","article-title":"Increased risk of cognitive impairment in cirrhoticpatients with bacterialinfections","volume":"59","author":"Merli","year":"2013","journal-title":"J. Hepatol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"936","DOI":"10.1126\/science.1214935","article-title":"Disease tolerance as a defense strategy","volume":"335","author":"Medzhitov","year":"2012","journal-title":"Science"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"722","DOI":"10.1111\/apt.16790","article-title":"Overt hepatic encephalopathy is an independent risk factor for de novo infection in cirrhotic patients with acute decompensation","volume":"55","author":"Alabsawy","year":"2022","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"744","DOI":"10.1111\/apt.16809","article-title":"Editorial: Infections and hepatic encephalopathy-does the chicken or the egg come FIRST? A novel perspective at the horizon","volume":"55","author":"Riggio","year":"2022","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1002\/cld.457","article-title":"Management of hepatic encephalopathy as an inpatient","volume":"5","author":"Riggio","year":"2015","journal-title":"Clin. Liver Dis."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"European Association for the Study of the Liver (2018). EASL Clinical Practice Guidelines for the management of patients with decompensated cirrhosis. J. Hepatol., 69, 406\u2013460.","DOI":"10.1016\/j.jhep.2018.08.009"},{"key":"ref_34","first-page":"567","article-title":"Predictive factor for hepatic encephalopathy in cirrhotic patients who presented with acute variceal bleeding","volume":"97","author":"Rattanasupar","year":"2014","journal-title":"J. Med. Assoc. Thai."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"996","DOI":"10.1111\/j.1440-1746.2010.06596.x","article-title":"Prophylaxis of hepatic encephalopathy in acute variceal bleed: A randomized controlled trial of lactulose versus no lactulose","volume":"26","author":"Sharma","year":"2011","journal-title":"J. Gastroenterol. Hepatol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1159\/000346083","article-title":"Lactulose is highly potential in prophylaxis of hepatic encephalopathy in patients with cirrhosis and upper gastrointestinal bleeding: Results of a controlled randomized trial","volume":"87","author":"Wen","year":"2013","journal-title":"Digestion"},{"key":"ref_37","first-page":"3015891","article-title":"PrimaryProphylaxis to Prevent the Development of Hepatic Encephalopathy in Cirrhotic Patients with Acute Variceal Bleeding","volume":"2018","author":"Alla","year":"2018","journal-title":"Can. J. Gastroenterol. Hepatol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"621","DOI":"10.1007\/s12664-021-01150-2","article-title":"Role of lactulose for prophylaxis against hepatic encephalopathy in cirrhotic patients with upper gastrointestinal bleeding: A randomized trial","volume":"40","author":"Rattanasupar","year":"2021","journal-title":"Indian J. Gastroenterol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"959","DOI":"10.1016\/j.jhep.2021.12.022","article-title":"Baveno VII Faculty. Baveno VII\u2014Renewing consensus in portal hypertension","volume":"76","author":"Bosch","year":"2022","journal-title":"J. Hepatol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1173","DOI":"10.1136\/gutjnl-2019-320221","article-title":"Transjugular intrahepatic portosystemic stent-shunt in the management of portal hypertension","volume":"69","author":"Tripathi","year":"2020","journal-title":"Gut"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1016\/j.cld.2021.08.003","article-title":"Endoscopic Treatment of Esophageal Varices","volume":"26","author":"Zuckerman","year":"2022","journal-title":"Clin. Liver Dis."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"2166","DOI":"10.1007\/s10620-017-4630-y","article-title":"A New Look at Precipitants of Overt Hepatic Encephalopathy in Cirrhosis","volume":"62","author":"Pantham","year":"2017","journal-title":"Dig. Dis. Sci."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"3335","DOI":"10.1007\/s10620-016-4261-8","article-title":"Diabetes Is Associated with Clinical Decompensation Events in Patients with Cirrhosis","volume":"61","author":"Liu","year":"2016","journal-title":"Dig. Dis. Sci."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1012","DOI":"10.1111\/j.1365-2036.2010.04257.x","article-title":"Predictors of the recurrence of hepatic encephalopathy in lactulose-treated patients","volume":"31","author":"Bajaj","year":"2010","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"575","DOI":"10.1016\/j.jceh.2021.09.008","article-title":"Clinical Implications, Evaluation, and Management of Hyponatremia in Cirrhosis","volume":"12","author":"Praharaj","year":"2022","journal-title":"J. Clin. Exp. Hepatol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1097\/MCG.0b013e3181aabbcd","article-title":"Serum sodium predicts prognosis in critically ill cirrhotic patients","volume":"44","author":"Jenq","year":"2010","journal-title":"J. Clin. Gastroenterol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1613","DOI":"10.1002\/hep.20237","article-title":"Effects of dilutional hyponatremia on brain organic osmolytes and water content in patients with cirrhosis","volume":"39","author":"Restuccia","year":"2004","journal-title":"Hepatology"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1382","DOI":"10.1038\/ajg.2009.293","article-title":"Hyponatremia is a risk factor of hepatic encephalopathy in patients with cirrhosis: A prospective study with time-dependent analysis","volume":"104","author":"Guevara","year":"2009","journal-title":"Am. J. Gastroenterol."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"1137","DOI":"10.1111\/j.1478-3231.2010.02293.x","article-title":"Risk factors for hepatic encephalopathy in patients with cirrhosis and refractory ascites: Relevance of serum sodium concentration","volume":"30","author":"Guevara","year":"2010","journal-title":"Liver Int."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1999","DOI":"10.1111\/jgh.14683","article-title":"Improvement of hyponatremia in cirrhosis is associated with improved complex information processing","volume":"34","author":"Watson","year":"2019","journal-title":"J. Gastroenterol. Hepatol."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"914","DOI":"10.1111\/jgh.14558","article-title":"Serum sodium as a risk factor for hepatic encephalopathy in patients with cirrhosis and ascites","volume":"34","author":"Bossen","year":"2019","journal-title":"J. Gastroenterol. Hepatol."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"52","DOI":"10.3810\/pgm.2001.02.850","article-title":"Hepatic encephalopathy. Metabolic consequence of cirrhosis often is reversible","volume":"109","author":"Vlahcevic","year":"2001","journal-title":"Postgrad. Med."},{"key":"ref_53","first-page":"e4363","article-title":"Precipitating Factors and Treatment Outcomes of Hepatic Encephalopathy in Liver Cirrhosis","volume":"11","author":"Poudyal","year":"2019","journal-title":"Cureus"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"1240","DOI":"10.1016\/S0399-8320(04)95217-7","article-title":"Increased oro-cecal transit time in grade I or II hepatic encephalopathy","volume":"28","author":"Bouin","year":"2004","journal-title":"Gastroenterol. Clin. Biol."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1177\/2050640617727179","article-title":"Benzodiazepines and risk for hepatic encephalopathy in patients with cirrhosis and ascites","volume":"6","author":"Watson","year":"2018","journal-title":"United Eur. Gastroenterol. J."},{"key":"ref_56","doi-asserted-by":"crossref","unstructured":"Di Cola, S., Nardelli, S., Ridola, L., Gioia, S., Riggio, O., and Merli, M. (2022). Ammonia and the Muscle: An Emerging Point of View on Hepatic Encephalopathy. J. Clin. Med., 11.","DOI":"10.3390\/jcm11030611"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1007\/s12072-018-9875-9","article-title":"Myosteatosis and sarcopenia are associated with hepatic encephalopathy in patients with cirrhosis","volume":"12","author":"Bhanji","year":"2018","journal-title":"Hepatol. Int."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1016\/j.cgh.2011.08.028","article-title":"Muscle wasting is associated with mortality in patients with cirrhosis","volume":"10","author":"Prado","year":"2012","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1002\/jcsm.12039","article-title":"Sarcopenic obesity and myosteatosis are associated with higher mortality in patients with cirrhosis","volume":"7","author":"Angulo","year":"2016","journal-title":"J. Cachexia Sarcopenia Muscle"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"1508","DOI":"10.1016\/j.dld.2019.09.004","article-title":"The additive value of sarcopenia, myosteatosis and hepatic encephalopathy in the predictivity of model for end-stage liver disease","volume":"51","author":"Lattanzi","year":"2019","journal-title":"Dig. Liver Dis."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"1704","DOI":"10.1002\/hep.30692","article-title":"Muscle Alterations Are Associated With Minimal and Overt Hepatic Encephalopathy in Patients With Liver Cirrhosis","volume":"70","author":"Nardelli","year":"2019","journal-title":"Hepatology"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1007\/s11011-012-9365-z","article-title":"Muscle depletion increases the risk of overt and minimal hepatic encephalopathy: Results of a prospective study","volume":"28","author":"Merli","year":"2013","journal-title":"Metab. Brain Dis."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"262","DOI":"10.1016\/j.jhep.2022.01.003","article-title":"Gut liver muscle brain axis: A comprehensive viewpoint on prognosis in cirrhosis","volume":"77","author":"Ridola","year":"2022","journal-title":"J. Hepatol."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"2940","DOI":"10.4254\/wjh.v7.i30.2940","article-title":"Nutritional assessment in cirrhotic patients with hepatic encephalopathy","volume":"7","author":"Romeiro","year":"2015","journal-title":"World J. Hepatol."},{"key":"ref_65","doi-asserted-by":"crossref","unstructured":"Faccioli, J., Nardelli, S., Gioia, S., Riggio, O., and Ridola, L. (2022). Nutrition Assessment and Management in Patients with Cirrhosis and Cognitive Impairment: A Comprehensive Review of Literature. J. Clin. Med., 11.","DOI":"10.3390\/jcm11102842"},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1002\/hep.26370","article-title":"The nutritional management of hepatic encephalopathy in patients with cirrhosis: International Society for Hepatic Encephalopathy and Nitrogen Metabolism Consensus","volume":"58","author":"Amodio","year":"2013","journal-title":"Hepatology"},{"key":"ref_67","doi-asserted-by":"crossref","unstructured":"European Association for the Study of the Liver (2019). EASL Clinical Practice Guidelines on nutrition in chronic liver disease. J. Hepatol., 70, 172\u2013193.","DOI":"10.1016\/j.jhep.2018.06.024"},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1007\/s11011-008-9127-0","article-title":"Dietary and nutritional indications in hepatic encephalopathy","volume":"24","author":"Merli","year":"2009","journal-title":"Metab. Brain Dis."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"663","DOI":"10.1097\/MCG.0000000000001071","article-title":"Dietary Interventions in Liver Cirrhosis","volume":"52","author":"Yao","year":"2018","journal-title":"J. Clin. Gastroenterol."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"1920","DOI":"10.1016\/j.cgh.2014.04.016","article-title":"Eight weeks of exercise training increases aerobic capacity and muscle mass and reduces fatigue in patients with cirrhosis","volume":"12","author":"Zenith","year":"2014","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_71","first-page":"450","article-title":"Clinical and portal hemodynamic features in cirrhotic patients having a large spontaneous splenorenal and\/or gastrorenal shunt","volume":"81","author":"Ohnishi","year":"1986","journal-title":"Am. J. Gastroenterol."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1053\/j.tvir.2013.02.002","article-title":"Vascular anatomy and the morphologic and hemodynamic classifications of gastric varices and spontaneous portosystemic shunts relevant to the BRTO procedure","volume":"16","author":"Saad","year":"2013","journal-title":"Tech. Vasc. Interv. Radiol."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"1726","DOI":"10.3748\/wjg.v26.i15.1726","article-title":"Spontaneous porto-systemic shunts in livercirrhosis: Clinical and therapeuticalaspects","volume":"26","author":"Nardelli","year":"2020","journal-title":"World J. Gastroenterol."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"1694","DOI":"10.1053\/j.gastro.2018.01.028","article-title":"Baveno VI-SPSS group from the Baveno Cooperation. Association Between Portosystemic Shunts and Increased Complications and Mortality in Patients With Cirrhosis","volume":"154","author":"Roccarina","year":"2018","journal-title":"Gastroenterology"},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"1158","DOI":"10.1002\/hep.20905","article-title":"High prevalence of spontaneousportal-systemic shunts in persistenthepaticencephalopathy: A case-control study","volume":"42","author":"Riggio","year":"2005","journal-title":"Hepatology"},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1148\/radiol.2021203051","article-title":"Relevance of SpontaneousPortosystemic Shunts Detected with CT in Patients with Cirrhosis","volume":"299","author":"Nardelli","year":"2021","journal-title":"Radiology"},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"1140","DOI":"10.1016\/j.jhep.2019.12.021","article-title":"Baveno VI-SPSS group of the Baveno Cooperation. Total area of spontaneous portosystemic shunts independently predicts hepatic encephalopathy and mortality in liver cirrhosis","volume":"72","author":"Praktiknjo","year":"2020","journal-title":"J. Hepatol."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"1418","DOI":"10.1111\/apt.12771","article-title":"Improvement in survival associated with embolisation of spontaneous portosystemic shunt in patients with recurrent hepatic encephalopathy","volume":"39","author":"An","year":"2014","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"2448","DOI":"10.1002\/hep.26314","article-title":"EASL-CLIF-Consortium. Embolization of large spontaneous portosystemic shunts for refractory hepatic encephalopathy: A multicenter survey on safety and efficacy","volume":"57","author":"Laleman","year":"2013","journal-title":"Hepatology"},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"1200","DOI":"10.1016\/j.jvir.2012.05.046","article-title":"Efficacy of balloon-occluded retrograde transvenous obliteration of large spontaneous lienorenal shunt in patients with severe recurrent hepatic encephalopathy with foam sclerotherapy: Initial experience","volume":"23","author":"Mukund","year":"2012","journal-title":"J. Vasc. Interv. Radiol."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"1589","DOI":"10.1016\/j.jvir.2015.07.011","article-title":"Vascular Plug-Assisted Retrograde Transvenous Obliteration for the Treatment of Gastric Varices and Hepatic Encephalopathy: A Prospective Multicenter Study","volume":"26","author":"Gwon","year":"2015","journal-title":"J. Vasc. Interv. Radiol."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"e61","DOI":"10.1038\/ctg.2014.12","article-title":"Coil-Assisted Retrograde Transvenous Obliteration (CARTO) for the Treatment of Portal Hypertensive Variceal Bleeding: Preliminary Results","volume":"5","author":"Lee","year":"2014","journal-title":"Clin. Transl. Gastroenterol."},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1016\/j.cld.2011.12.008","article-title":"Hepaticencephalopathy after transjugularintrahepaticportosystemic shunt","volume":"16","author":"Riggio","year":"2012","journal-title":"Clin. Liver Dis."},{"key":"ref_84","first-page":"549","article-title":"Hepatic encephalopathy after transjugular intrahepatic portosystemic shunts: Incidence and risk factors","volume":"90","author":"Somberg","year":"1995","journal-title":"Am. J. Gastroenterol."},{"key":"ref_85","doi-asserted-by":"crossref","unstructured":"Nardelli, S., Bellafante, D., Ridola, L., Faccioli, J., Riggio, O., and Gioia, S. (2022). Prevention of post-tips hepatic encephalopathy: The search of the ideal candidate. Metab. Brain Dis.","DOI":"10.1007\/s11011-022-01131-0"},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"2704","DOI":"10.3748\/wjg.v20.i10.2704","article-title":"TIPS improves liver transplantation-free survival in cirrhotic patients with refractory ascites: An updated meta-analysis","volume":"20","author":"Bai","year":"2014","journal-title":"World J. Gastroenterol."},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"2738","DOI":"10.1111\/j.1572-0241.2008.02102.x","article-title":"Incidence, natural history, and risk factors of hepatic encephalopathy after transjugular intrahepatic portosystemic shunt with polytetrafluoroethylene-covered stent grafts","volume":"103","author":"Riggio","year":"2008","journal-title":"Am. J. Gastroenterol."},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"674","DOI":"10.1016\/j.jhep.2004.12.028","article-title":"Pharmacological prophylaxis of hepatic encephalopathy after transjugular intrahepatic portosystemic shunt: A randomized controlled study","volume":"42","author":"Riggio","year":"2005","journal-title":"J. Hepatol."},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"633","DOI":"10.7326\/M20-0202","article-title":"The Use of Rifaximin in the Prevention of Overt Hepatic Encephalopathy After Transjugular Intrahepatic Portosystemic Shunt: A Randomized Controlled Trial","volume":"174","author":"Bureau","year":"2021","journal-title":"Ann. Intern. Med."},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"508","DOI":"10.1016\/j.jhep.2017.05.006","article-title":"Eight millimetre covered TIPS does not compromise shunt function but reduces hepatic encephalopathy in preventing variceal rebleeding","volume":"67","author":"Wang","year":"2017","journal-title":"J. Hepatol."},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1016\/j.ejrad.2017.01.032","article-title":"The underdilation of nitinol stents at TIPS implantation: Solution or illusion?","volume":"89","author":"Mollaiyan","year":"2017","journal-title":"Eur. J. Radiol."},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"1153","DOI":"10.1016\/j.cgh.2018.01.029","article-title":"Under-dilated TIPS Associate With Efficacy and Reduced Encephalopathy in a Prospective, Non-randomized Study of Patients with Cirrhosis","volume":"16","author":"Schepis","year":"2018","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"871","DOI":"10.1111\/liv.14050","article-title":"The modification of quantity and quality of muscle mass improves the cognitive impairment after TIPS","volume":"39","author":"Gioia","year":"2019","journal-title":"Liver Int."},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"711","DOI":"10.1148\/radiol.211172","article-title":"Sarcopenia in Patients with Cirrhosis after Transjugular Intrahepatic Portosystemic Shunt Placement","volume":"303","author":"Liu","year":"2022","journal-title":"Radiology"},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"1071","DOI":"10.1056\/NEJMoa0907893","article-title":"Rifaximin treatment in hepatic encephalopathy","volume":"362","author":"Bass","year":"2010","journal-title":"N. Engl. J. Med."},{"key":"ref_96","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1016\/j.cld.2020.01.009","article-title":"Novel Therapies in Hepatic Encephalopathy","volume":"24","author":"Alimirah","year":"2020","journal-title":"Clin. Liver Dis."},{"key":"ref_97","first-page":"CD008716","article-title":"Probiotics for people with hepatic encephalopathy","volume":"2","author":"Dalal","year":"2017","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_98","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1016\/j.hbpd.2018.01.005","article-title":"Effect of probiotic treatment on cirrhotic patients with minimal hepatic encephalopathy: A meta-analysis","volume":"17","author":"Cao","year":"2018","journal-title":"Hepatobiliary Pancreat. Dis. Int."},{"key":"ref_99","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1016\/j.gastrohep.2021.05.009","article-title":"Fecal microbiota transplant, its usefulness beyond Clostridioides difficile in gastrointestinal diseases","volume":"45","author":"Quera","year":"2022","journal-title":"Gastroenterol. Hepatol."},{"key":"ref_100","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1002\/hep.28121","article-title":"Fecal microbiota transplantation in the management of hepatic encephalopathy","volume":"63","author":"Kao","year":"2016","journal-title":"Hepatology"},{"key":"ref_101","doi-asserted-by":"crossref","first-page":"1727","DOI":"10.1002\/hep.29306","article-title":"Fecal microbiota transplant from a rational stool donor improves hepatic encephalopathy: A randomized clinical trial","volume":"66","author":"Bajaj","year":"2017","journal-title":"Hepatology"},{"key":"ref_102","doi-asserted-by":"crossref","first-page":"1690","DOI":"10.1002\/hep.30690","article-title":"Fecal Microbial Transplant Capsules Are Safe in Hepatic Encephalopathy: A Phase 1, Randomized, Placebo-Controlled Trial","volume":"70","author":"Bajaj","year":"2019","journal-title":"Hepatology"},{"key":"ref_103","doi-asserted-by":"crossref","first-page":"625","DOI":"10.1016\/j.jceh.2021.08.027","article-title":"Gut Barrier and Microbiota in Cirrhosis","volume":"12","author":"Philips","year":"2022","journal-title":"J. Clin. Exp. Hepatol."},{"key":"ref_104","first-page":"e25537","article-title":"A Systematic Review of the Efficacy and Safety of Fecal Microbiota Transplantation in the Treatment of Hepatic Encephalopathy and Clostridioides difficile Infection in Patients with Cirrhosis","volume":"14","author":"Tun","year":"2022","journal-title":"Cureus"},{"key":"ref_105","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1007\/s40265-018-1023-2","article-title":"Pharmacokinetic and Pharmacodynamic Properties of L-Ornithine L-Aspartate (LOLA) in Hepatic Encephalopathy","volume":"79","author":"Kircheis","year":"2019","journal-title":"Drugs"},{"key":"ref_106","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1007\/s11011-019-00463-8","article-title":"Beneficial effects of L-ornithine L-aspartate for prevention of overt hepatic encephalopathy in patients with cirrhosis: A systematic review with meta-analysis","volume":"35","author":"Butterworth","year":"2020","journal-title":"Metab. Brain Dis."},{"key":"ref_107","doi-asserted-by":"crossref","first-page":"725","DOI":"10.1097\/MEG.0b013e32834696f5","article-title":"A randomized controlled trial comparing lactulose, probiotics, and L-ornithine L-aspartate in treatment of minimal hepatic encephalopathy","volume":"23","author":"Mittal","year":"2011","journal-title":"Eur. J. Gastroenterol. Hepatol."},{"key":"ref_108","first-page":"CD012410","article-title":"L-ornithine L-aspartate for prevention and treatment of hepatic encephalopathy in people with cirrhosis","volume":"5","author":"Goh","year":"2018","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_109","doi-asserted-by":"crossref","first-page":"1194","DOI":"10.1002\/hep.32255","article-title":"L-ornithine L-aspartate in acute treatment of severe hepatic encephalopathy: A double-blind randomized controlled trial","volume":"75","author":"Jain","year":"2022","journal-title":"Hepatology"},{"key":"ref_110","doi-asserted-by":"crossref","first-page":"e000648","DOI":"10.1136\/bmjgast-2021-000648","article-title":"Polyethylene glycol versus lactulose in the treatment of hepatic encephalopathy: A systematic review and meta-analysis","volume":"8","author":"Hoilat","year":"2021","journal-title":"BMJ Open Gastroenterol."},{"key":"ref_111","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1097\/MCG.0000000000001621","article-title":"Comparative Effectiveness and Safety of Polyethylene Glycol Electrolyte Solution Versus Lactulose for Treatment of Hepatic Encephalopathy: A Systematic Review and Meta-analysis","volume":"56","author":"Li","year":"2022","journal-title":"J. Clin. Gastroenterol."},{"key":"ref_112","first-page":"CD001939","article-title":"Branched-chain amino acids for people with hepatic encephalopathy","volume":"5","author":"Gluud","year":"2017","journal-title":"Cochrane Database Syst. Rev."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/3\/1187\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T18:22:14Z","timestamp":1760120534000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/3\/1187"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,2,2]]},"references-count":112,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2023,2]]}},"alternative-id":["jcm12031187"],"URL":"https:\/\/doi.org\/10.3390\/jcm12031187","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,2,2]]}}}