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I Putu Arya Giri Prebawa
Universitas Warmadewa
Health Professions Medicine & Pharmacology Nursing

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Transformasi Paradigma Ensefalopati Hepatikum: Integrasi Gut–Liver–Brain Axis, Neuroinflamasi, dan Biomarker Modern I Putu Arya Giri Prebawa
Jurnal Ners Vol. 10 No. 1 (2026): JANUARI 2026
Publisher : Universitas Pahlawan Tuanku Tambusai

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.31004/jn.v10i1.53474

Abstract

Hepatic encephalopathy (HE) is increasingly recognized as a complex neuropsychiatric disorder driven by multidimensional interactions within the gut–liver–brain axis rather than ammonia toxicity alone. Recent evidence demonstrates that the synergy between hyperammonemia, systemic inflammation, microbiota dysbiosis, and metabolite dysregulation—particularly bile acids—triggers microglial activation, astrocytic dysfunction, and blood–brain barrier disruption. Sarcopenia and myosteatosis further impair ammonia detoxification and reduce neuroprotective signaling. Emerging biomarkers, including neurofilament light chain (NfL), YKL-40, bile-acid panels, and functional neuroimaging (rs-fMRI, DTI), provide improved sensitivity for early detection of subclinical impairment. Therapeutic strategies now extend beyond ammonia reduction to microbiota modulation (rifaximin, FMT), next-generation ammonia scavengers, and muscle-targeted interventions. Integration of metabolomic profiles with artificial intelligence supports the development of precision medicine approaches, enabling accurate risk stratification and personalized therapeutic planning. This article summarizes the evolving pathophysiological paradigm, diagnostic advances, and future therapeutic innovations in HE.
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