Hepatic encephalopathy in chronic liver disease: 2014 Practice Guideline by the American Association for the Study Of Liver Diseases and the European Association for the Study of the Liver

Vilstrup, Hendrik; Amodio, Piero; Bajaj, Jasmohan S.; Córdoba, Juan; Ferenci, Péter; Mullen, Kevin D.; Weißenborn, Karin; Wong, Philip

doi:10.1002/hep.27210

Cited by 1,681 publications

(1,983 citation statements)

References 163 publications

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“…Testing for MHE is important, as it may progress to overt hepatic encephalopathy, indicate poor quality of life and reduced socioeconomic potential [1] . Diagnostic tests for MHE should be easy to use, valid, less time consuming and reliable.…”

Section: Resultsmentioning

confidence: 99%

“…According to recent guidelines (AASLD/EASL 2014), hepatic encephalopathy is a brain dysfunction caused by liver insufficiency and/or portosystemic shunting; it manifests as a wide spectrum of neurological or psychiatric abnormalities ranging from subclinical alterations to coma [1] . Patients with cirrhosis with normal neurologic and mental examination can present minimal forms of HE, showing intellectual function impairment that cannot be detected through general clinical examination but can be unveiled using specific neuropsychologic and neurophysiologic tests [2] .…”

Section: Introductionmentioning

confidence: 99%

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Validity of Inhibitory Control Test and Critical Flicker Frequency to Diagnose Minimal Hepatic Encephalopathy

Rathore

Shende

Agrawal

et al. 2017

Journal of Gastroenterology and Hepatology Research

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tests. On these 33 patients, ICT and CFF were applied. 35 healthy subjects served as controls for the ICT and CFF. RESULTS: Taking > 9 lures as positive ICT according to receiver operator characteristic (ROC) curve, the sensitivity, specificity, PPV and NPV were 90.9%, 37.1%, 57.6%, 81.3% respectively. Cirrhotics with MHE had significantly higher lures (22 ± 7.8 vs 11 ± 5.6, p < 0.001) or (56% vs 28%) and lower target response (90% vs 97%) compared with controls. For CFF taking < 37 Hz as cut-off, the sensitivity, specificity, PPV and NPV were 57.5%, 94.3%, 90.5% and 70.2%. We also found that CFF is less time consuming as compare to ICT. CONCLUSION: ICT and CFF are useful tools to assess MHE. CFF to be less time to consume, less sensitive but more specific than ICT. INTRODUCTIONHepatic encephalopathy (HE) is a complex neuropsychiatric syndrome present in patients with chronic or acute liver disease after exclusion of other brain diseases. According to recent guidelines (AASLD/EASL 2014), hepatic encephalopathy is a brain dysfunction caused by liver insufficiency and/or portosystemic shunting; it manifests as a wide spectrum of neurological or psychiatric abnormalities ranging from subclinical alterations to coma [1] . Patients with cirrhosis with normal neurologic and mental examination can present minimal forms of HE, showing intellectual function impairment that cannot be detected through general clinical examination but can be unveiled using specific neuropsychologic and neurophysiologic tests [2] . MHE has significant negative impact on

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Validity of Inhibitory Control Test and Critical Flicker Frequency to Diagnose Minimal Hepatic Encephalopathy

Rathore

Shende

Agrawal

et al. 2017

Journal of Gastroenterology and Hepatology Research

View full text Add to dashboard Cite

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“…Dietary interventions that avoid starvation physiology are helpful, such as with small meals through the day and a late-night snack. 51 Narcotics and benzodiazepines worsen encephalopathy and should be avoided including replacement of benzodiazepinederived sleep aids with diphenhydramine, melatonin, or trazodone. Patients with a TIPS who continue to experience refractory encephalopathy may need their TIPS downsized 52 or have an evaluation for portosystemic shunt embolization.…”

Section: Hepatic Encephalopathymentioning

confidence: 99%

Keeping high model for end‐stage liver disease score liver transplantation candidates alive

et al. 2015

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“…Thus, the diagnosis of overt, or clinically apparent, HE is based on a careful and detailed neuropsychiatric history and examination and exclusion of other potential causes of neuropsychiatric abnormalities; collateral evidence may be obtained from psychometric and neurophysiological testing. The diagnosis of minimal HE relies on the exclusion of symptoms and signs of overt HE and the finding of impaired psychomotor performance and/or abnormal neurophysiology.Cerebral imaging should be undertaken when patients with cirrhosis first present with neuropsychiatric abnormalities in order to exclude alternative diagnoses (AASLD/EASL, 2014;Vilstrup et al, 2014) and again later if there is any suspicion of alternative neurological pathology. Less certain, however, is the role of cerebral imaging in the diagnosis of HE per se, despite the fact that numerous cerebral imaging studies, using increasingly sophisticated technologies, have been undertaken in these patients over the last two decades (Alonso et al, 2014).…”

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confidence: 99%

“…Associations for the Study of the Liver hepatic encephalopathy was defined as 'a brain dysfunction caused by liver insufficiency or portal systemic shunting' (AASLD/EASL, 2014; Vilstrup et al, 2014).…”

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confidence: 99%

Quantitative magnetic resonance imaging in patients with cirrhosis: a cross-sectional study

et al. 2015

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2Cerebral magnetic resonance imaging was undertaken, at 3 Tesla field strength, employing magnetization transfer (MT) and diffusion-weighted imaging (DWI) sequences, in 26 patients with well-compensated cirrhosis, free of overt hepatic encephalopathy. Results were compared to those from 18 aged-matched healthy volunteers. Cerebral magnetization transfer ratios (MTR) were reduced in the frontal white matter, caudate, putamen and globus pallidus in patients with cirrhosis, compared to healthy controls, while the apparent diffusion coefficients ( A D C ) o n D W I were significantly increased in the genu and body of the corpus callosum. An association between previous excessive alcohol consumption and both MTR and ADCs was noted, but this association was lost when controls were exercised for the severity of liver disease and psychometric impairment on multivariate analysis. Eight (31%) of the 26 patient had impaired psychometric performance consistent with a diagnosis of minimal hepatic encephalopathy. No statistically significant difference in regional cerebral MTRs or ADCs were found in relation to neuropsychiatric status, although there was a trend towards lower MTRs in patients with impaired psychometric performance. The alterations in MTR and ADC in the patients with functionally compensated cirrhosis are compatible with theories governing the genesis of hepatic encephalopathy, including changes in astrocyte membrane permeability, with subsequent redistribution of macromolecules.Key words: apparent diffusion coefficients; diffusion-weighted imaging; hepatic encephalopathy; magnetic resonance imaging; magnetization transfer ratios 3 Hepatic encephalopathy (HE) is the term used to describe the spectrum of neuropsychiatric changes that can be observed in patients with cirrhosis. In the recent guideline published jointly by the European and AmericanAssociations for the Study of the Liver hepatic encephalopathy was defined as 'a brain dysfunction caused by liver insufficiency or portal systemic shunting' (AASLD/EASL, 2014;Vilstrup et al., 2014).Clinically apparent or overt HE manifests as a neuropsychiatric syndrome encompassing a wide spectrum of mental and motor disorders (Weissenborn, 1998;Ferenci et al., 2002). Individuals with overt HE also show a wide spectrum of other abnormalities, including impaired psychomotor performance (Schomerus & Hamster, 1998) and disturbed neurophysiological function (Parsons-Smith et al., 1957;Chu et al., 1997). The term minimal HE is used to describe patients with cirrhosis who are 'clinically normal', but who show abnormalities in neuropsychometric and/or neurophysiological performance (Ferenci et al., 2000).The presence of HE, whether minimal or overt, is associated with significant impairment in the performance of complex tasks, such as driving (Bajaj et al., 2007;Schomerus et al., 1981;Wein et al., 2004); healthrelated quality of life (Groeneweg et al., 1998); earning potential (Schomerus & Hamster 2001); safety (Roman et al., 2011); neurocognitive function post-transplantati...

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Hepatic encephalopathy in chronic liver disease: 2014 Practice Guideline by the American Association for the Study Of Liver Diseases and the European Association for the Study of the Liver

Cited by 1,681 publications

References 163 publications

Validity of Inhibitory Control Test and Critical Flicker Frequency to Diagnose Minimal Hepatic Encephalopathy

Validity of Inhibitory Control Test and Critical Flicker Frequency to Diagnose Minimal Hepatic Encephalopathy

Keeping high model for end‐stage liver disease score liver transplantation candidates alive

Quantitative magnetic resonance imaging in patients with cirrhosis: a cross-sectional study

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