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Hepatic encephalopathy (HE) represents a common and debilitating complication of cirrhosis, with a heterogeneous range of symptoms, severity, time course and impact on both patients and caregivers alike. HE represents a transitional point in the natural history of chronic liver disease and is associated with a substantial decline in quality of life, alongside increased healthcare resource utilisation and mortality.Treatment goals for HE centre on improvement in quality of life, prevention of episodes of both overt HE and other acute decompensating events associated with cirrhosis and portal hypertension. Multidisciplinary teams, including specialists in hepatology, nutrition, nursing, physiotherapy, social workers and, where appropriate, palliative medicine, help to provide comprehensive and holistic care and are important in securing the best patient outcomes.Part 3 of this review series focuses on the outpatient management of HE in addition to considering distinct clinical presentations and specific challenges posed by HE. We outline approaches to assessing the severity of HE and response to treatment. We discuss patient and carer education and highlight its importance for empowering community management, optimising medical treatment and reducing hospital admissions and resource utilisation. We outline a stepwise algorithm for the treatment of symptomatic HE, including non-absorbable disaccharides, rifaximin-α and L-Ornithine L-Aspartate and discuss when to refer for transplant assessment. Furthermore, we highlight challenges in therapeutic drug development in this field and propose a framework for consideration of trial endpoints in patients with either covert or a history of overt HE, recognising the need for modern trial designs in delivering translational therapeutics.