Liver and Brain Disorders

This review provides a concise update on recent developments in liver and brain interactions traversing encephalopathy in acute, acute on chronic liver failure, and non-cirrhotic liver disease.

An interconnected axis of gut-microbiota changes, systemic inflammation, and mediators of neuroinflammation impact liver-brain interaction. Encephalopathy in acute on chronic liver failure has its own trajectories. Newer drugs and techniques show promise, while established therapies have newer indications.

Neurogliovascular unit dysfunction and cross-talk abnormalities play an important role in brain dysfunction in liver disease. Ammonia is central to pathogenesis and has different implications in different settings of liver failure (acute/chronic/acute on chronic). Beyond cirrhosis, neurological dysfunction is common in non-cirrhotic portal hypertension, chronic viral hepatitis, and metabolic dysfunction associated steatotic liver disease. Newer therapies are promising, and future research should focus on further refinement of the pathophysiological basis for targeted therapies according to the type of encephalopathy.