Symptoms of HE

How to recognize the symptoms of HE

If you have liver disease, it is important to know the symptoms of HE. By paying close attention to your mental and physical symptoms, you can alert your doctor before things get worse.

HE can be either “covert” or “overt” depending on the degree of the symptoms:

  • Covert HE symptoms can go unnoticed, even by a doctor
  • Overt HE symptoms are more noticeable to other people

Symptoms of overt HE can include:


  • Lack of energy or interest
  • Confusion
  • Not knowing where you are or where you’re going
  • Inappropriate behavior
  • Severe personality changes


  • Sleepiness or change in sleep patterns
  • Worsening of handwriting
  • Loss of small hand movements
  • Tremors or shaking of hands or arms
  • Breath with a musty or sweet odor

These symptoms can also be found in older people with Alzheimer’s or dementia, but when they occur in people with liver disease, it may be HE.

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Cover of checklist

If you have some form of liver disease and you start to develop any of these symptoms, it is important that you talk about them with your doctor.

Download this easy-to-use checklist by clicking below, fill it out, and talk to your loved one’s doctor about any mental or physical symptoms you’ve noticed.

Causes of overt HE

Overt HE happens when your liver cannot filter toxins in your blood and the toxins build up and reach your brain

The liver is important because it filters your blood, including everything that you eat and drink, such as food, alcohol, and medicines. It helps process food into energy and nutrients that your body can use. It also gets rid of toxins in your blood, which otherwise may be harmful to your body.

When your liver is damaged, it cannot remove toxins as well as a healthy liver can. When toxins build up in your brain, you may have short-term and long-term effects that can get worse over time.

Risks of overt HE

Symptoms of hepatic encephalopathy occur during overt HE “episodes”

When HE symptoms become more severe, the condition is called “overt HE.” If you have overt HE, you may have experienced what is called an “episode” of overt HE.

During an episode, your symptoms can become more obvious. There may be a change in your behavior or personality. You may not understand what is happening, and people around you may notice that you are acting strangely.

These episodes can get worse over time and may result in:

Worsening symptoms

Studies suggest that problems with memory and learning could get worse after repeated episodes of overt HE, and damage may be permanent.


According to one source, >50% of patients with overt HE were admitted to the hospital for HE episodes. In fact, more than 1 in 3 of these patients were readmitted to the hospital a second time within 30 days for another episode.

If you have overt HE, learn more about XIFAXAN today and then talk to your doctor.

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