Hepatic encephalopathy (HE) is a common complication of advanced liver disease. The first-line treatment includes agents that counter the high levels of ammonia, which are thought to play a central role in the disease.

  • What information do ammonia measurements provide and what is the relationship with hepatic encephalopathy?
  • Is the term “Covert HE” clinically useful?
  • And, is it time to rethink the standard of care?

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Q&A document

EASL Studio Q&A for JHEP Live episode



Paolo Angeli Paolo Angeli is Head of the Unit of Internal Medicine and Hepatology and Full Professor of Medicine at the University of Padova, Italy. He leads a research team which focuses on the pathophysiology and treatment of acute, chronic, and acute-on-chronic liver failure and liver transplantation, and has authored numerous international guidelines and positional papers for EASL. Professor Angeli is Editor-in-Chief of the Journal of Hepatology and Chair of the EASL-CLIF Consortium (European Association for the Study of Chronic Liver Failure).


Rajiv Jalan Rajiv Jalan is a clinician scientist. He is a Professor of Hepatology at UCL, Scientific Director of EFCLIF and the previous Editor in Chief of Journal of Hepatology. His main interests are in understanding the molecular mechanisms underlying the pathogenesis of organ dysfunction in liver failure and using the knowledge to develop new therapies. His research has led to discovery of several novel therapeutic approaches, the publication of over 480 peer-reviewed papers and his H-Index on Google Scholar is 100.
Debbie Shawcross

Debbie Shawcross is a Clinician Scientist and Professor in Hepatology and Chronic Liver Failure at the Institute of Liver Studies (ILS), King’s College Hospital and the James Black Centre, King’s College London. She works as a Consultant Hepatologist on the King’s Liver Unit with a specialist interest in hepatic encephalopathy and the complications of cirrhosis. The aims of her research programme are to characterise the immunobiology of chronic liver failure focusing specifically on the gut-liver-brain axis in the context of the gut microbiome as a driver of immune dysfunction, inflammation, and encephalopathy.  She is also the Chief Investigator of the NIHR-funded EME UK multicentre randomised placebo-controlled clinical trial of faecal microbiota transplantation (capsules) [PROMISE Trial] in patients with metabolic-associated and alcohol-related cirrhosis.

Sara Montagnese

Sara Montagnese is an Associate Professor of Medicine and Honorary Consultant Physician at Padova University Hospital, in Italy. From 1 June 2022 she will also be a part-time Full Professor of Chronobiology at the University of Surrey, in the UK. She is Past President of the International Society for Hepatic Encephalopathy and Nitrogen Metabolism (ISHEN) and a member of the Governing Boards of the Italian Association for the Study of the Liver (AISF) and the European Biological Rhythms Society (EBRS). She is Associate Editor and Special Section Editor (Snapshots) of Journal of Hepatology, and Associate Editor of Frontiers in Physiology – Chronobiology. She has also been part of the Editorial Boards of Hepatology and BMJ-Open Gastroenterology.