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As a result, an uptick in the clinical and healthcare burdens related to this complication is expected in the coming years that will greatly affect the healthcare systems.1 In Mexico in 2009, the Clinical guidelines on HE diagnosis and treatment were published in 3 parts, divided into (1) generalities,2 (2) pathophysiology and diagnosis,3 and (3) treatment and future perspectives.4 After nearly 14 years, an update is now indispensable, given the scientific advances that have come about over that period of time, resulting in numerous new developments in diagnostic and therapeutic tools that are now essential for daily clinical practice