Review of the final report of the 1998 Working Party on definition, nomenclature and diagnosis of hepatic encephalopathy.

The heterogeneity and variability of the manifestations of hepatic encephalopathy among patients and in individual patients over time make the condition difficult to diagnose and to categorize with respect to severity. Recognizing these challenges, the World Congress of Gastroenterology formed a Working Party of hepatologists, neurologists and basic scientists in 1998 to develop consensus recommendations regarding key issues relevant to the diagnosis and grading of hepatic encephalopathy in clinical research and practice. This paper discusses the Working Party recommendations, which warrant re-examination in the context of the absolute need for consistency in diagnosis and grading of hepatic encephalopathy and in approaches to its clinical study. The Working Party recommendations provide a framework for achieving this consistency and can serve as a springboard for further refinements in diagnostic tests and procedures and in clinical-trial methodology.