Published online Jun 27, 2019. doi: 10.4254/wjh.v11.i6.489
Peer-review started: March 15, 2019
First decision: April 22, 2019
Revised: May 15, 2019
Accepted: May 20, 2019
Article in press: May 21, 2019
Published online: June 27, 2019
Core tip: Hepatic encephalopathy (HE) is a serious complication of cirrhosis resulting from a multifactorial impairment of gut-liver-brain axis functioning. Multiple interrelated factors (e.g., intestinal hyperpermeability, dysbiosis, hyperammonemia, inflammation) cooperate in its development. “Gut-centric” therapies, including non-absorbable disaccharides, antibiotics, prebiotics, probiotics, and fecal microbiota transplantation have been successfully employed to manage HE: pertinent current knowledge will be reviewed. Furthermore, the utility of dietary modifications in this context is increasingly recognized, thus opening a new promising research path. This review sheds light on dietary therapeutic strategies for HE, exploring how they can target the mechanisms underlying gut-liver-brain axis dysregulation.