ACG HE 2026 — ACG Clinical Guideline: Hepatic Encephalopathy

Diagnose overt hepatic encephalopathy clinically while identifying and treating precipitants. Lactulose remains first-line therapy for overt HE and should be titrated to clinical response rather than excessive catharsis; rifaximin is used as add-on therapy to reduce recurrence in appropriate patients. Ammonia concentration alone does not establish or grade the clinical severity of HE.