The American College of Gastroenterology’s first comprehensive guideline on hepatic encephalopathy (HE) marks a notable shift: from clinician-driven protocols to patient-centered, real-world management of a complex, often underdiagnosed condition.
Led by Dr. Jasmohan Bajaj, the guidance challenges long-held clinical habits—most notably the overreliance on ammonia levels—arguing instead for symptom-driven assessment and practical cognitive testing that can actually be implemented in routine care.
But the deeper change is philosophical. HE is no longer framed purely as a hepatic complication—it’s positioned as a multidimensional disease affecting cognition, caregivers, and quality of life, requiring involvement beyond the physician.