Management of Covert Hepatic Encephalopathy

Mullen, Kevin D.; Prakash, Ravi

doi:10.1016/j.cld.2011.12.006

Cited by 11 publications

(7 citation statements)

References 73 publications

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“…The diagnosis of CHE has clinical relevance because it is associated with poor health-related quality of life, increased progression to OHE, difficulty in driving and work, and negatively affects socioeconomic status 11, 13–15 . Recent studies have also demonstrated that CHE treatment can improve cognitive outcomes however treatment of CHE without testing is not necessarily cost-effective 16, 17 . Our results are in sync with the prior experience with the old Stroop App in that similar prior HE studies, we found that the psychomotor function, i.e.…”

Section: Discussionmentioning

confidence: 99%

Validation of EncephalApp, Smartphone-Based Stroop Test, for the Diagnosis of Covert Hepatic Encephalopathy

Bajaj

Heuman

Sterling

et al. 2015

Clinical Gastroenterology and Hepatology

135

124

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Background & Aims Detection of covert hepatic encephalopathy (CHE) is difficult but point of care testing could increase rates of diagnosis. We aimed to validate the ability of the smartphone app EncephalApp, a streamlined version of Stroop App, to detect CHE. We evaluated face validity, test–retest reliability, and external validity. Methods Patients with cirrhosis (n=167; 38% with overt HE [OHE]; mean age, 55 years; mean model for end-stage liver disease score, 12) and controls (n=114) were each given a paper and pencil cognitive battery (standard) along with EncephalApp. EncephalApp has Off and On states; results measured were: OffTime, OnTime, OffTime+OnTime, and number of runs required to complete 5 off and on runs. Thirty-six patients with cirrhosis underwent driving simulation tests, and EncephalApp results were correlated with results. Test–retest reliability was analyzed in a subgroup of patients. The test was performed before and after transjugular intra-hepatic portosystemic shunt placement, before and after correction for hyponatremia, to determine external validity. Results All patients with cirrhosis performed worse on paper and pencil and EncephalApp tests than controls. Patients with cirrhosis and OHE performed worse than those without OHE. Age-dependent EncephalApp cut-offs (younger or older than 45 years) were set. An OffTime+OnTime value of >190 seconds identified all patients with CHE with an area under the receiver operator characteristic (AUROC) value of 0.91; the AUROC value was 0.88 for diagnosis of CHE in those without OHE. EncephalApp times correlated with crashes and illegal turns in driving simulation tests. Test–retest reliability was high (intra-class coefficient, 0.83) among 30 patients retested 1–3 months apart. OffTime+OnTime increased significantly (206 vs 255, P=.007) among 10 patients retested 33±7 days after transjugular intra-hepatic portosystemic shunt placement. OffTime+OnTime decreased significantly (242 vs 225, P=.03) in 7 patients tested before and after correction for hyponatremia (126±3 to 132±4 meq/L, P=.01), 10±5 days apart. Conclusions A smartphone app called EncephalApp has good face validity, test–retest reliability, and external validity for the diagnosis of CHE.

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Section: Discussionmentioning

confidence: 99%

Validation of EncephalApp, Smartphone-Based Stroop Test, for the Diagnosis of Covert Hepatic Encephalopathy

Bajaj

Heuman

Sterling

et al. 2015

Clinical Gastroenterology and Hepatology

135

124

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“…HE includes the subtypes minimal hepatic encephalopathy (MHE) and overt hepatic encephalopathy (OHE). It has been reported that the incidence of MHE in patients with chronic liver diseases is up to 50% [3], with more than 50% of patients diagnosed with MHE reported to develop OHE within 30 months [4]. Patients with MHE do not present with obvious clinical symptoms, demonstrating subtle abnormalities in intelligence, neurological function, and cerebral blood flow by fine intelligence tests or electroneurophysiological examinations [5], and patients with OHE do present with obvious clinical symptoms such as changes in temperament, sleepiness, and even coma.…”

Section: Introductionmentioning

confidence: 99%

Cerebral Hemodynamics and Cognitive Function in Cirrhotic Patients with Hepatic Encephalopathy

Zhou

Dong

Zhang

et al. 2016

Gastroenterology Research and Practice

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Aims. To investigate cerebral hemodynamics in cirrhotic patients with HE and to observe effects of treatment in cerebral hemodynamics and correlations among ammonia, cerebral hemodynamics, and cognitive function. Methods. There were four groups: healthy controls (group 1), cirrhosis without HE (group 2), cirrhosis with MHE (group 3), and cirrhosis with OHE (group 4). Ammonia and cerebral hemodynamics (by TCD) were assessed. Patients in group 3 were subsequently randomized to two subgroups: the control (group A) and the treated (group B, treated with lactulose for two months), and they were retested for ammonia and TCD after treatment. Results. Ammonia, Vm, Vd, PI, and RI were statistically different before treatment, and ammonia, PI, and RI levels paralleled the severity of HE (P < 0.05). In group B, Vd increased and ammonia, PI, and RI declined following treatment (P < 0.05), while there were no differences in group A (P > 0.05). Correlations were found between ammonia and Vd, PI, RI, NCT-A, and DST and also found between Vd, PI, RI, and NCT-A and DST (P < 0.05). Conclusions. This study revealed that cerebral hemodynamics were related to the severity of HE and cerebral autoregulation was impaired. There were tight correlations among ammonia, cerebral hemodynamics, and cognitive function, and, following treatment, cerebral hemodynamics improved.

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“…[43] and Mullen & Prakash (2012). [44] Lactulose exert a beneficial effect by many proposed ways: (1) (4) Beneficial effects on the gut microbiome: cirrhosis is associated with dysbiosis and changes to the colonic mucosal microbiome.…”

Section: World Journal Of Pharmacy and Pharmaceutical Sciencesmentioning

confidence: 99%

Biochemical and Pathophysiological Aspects of the Treatment of Hepatic Encephalopathy in Rats

Mobasher¹

2017

WJPPS

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Hepatic encephalopathy (HE) represents a diverse spectrum of complex neuropsychiatric disturbance resulting from liver disease and its concomitant metabolic and immunologic derangements.Hyperammonemia and inflammation cooperate to induce neurological alteration in hepatic encephalopathy. This study was conducted to elucidate the changes of serum, liver and brain proinflammatory cytokines in encephalopathy rats and to evaluate the hepato-protective activity of lactulose and/or taurine against thioacetamide (TAA) induced hepatic encephalopathy in rats. Acute hepatic encephalopathy (HE) in rats was induced by intraperitoneal injection of thioacetamide in 24 hours intervals for two consecutive days. The obtained results revealed a significant (p<0.05) increase in the levels of serum liver function tests (ALT, AST, ALP & bilirubin) in TAA rats group than those in control ones. In addition, the levels of ammonia and proinflammatory cytokines (IL-6, IL-1β & TNF-α) in serum, liver and brain were significantly (p<0.05) increased associated with a remarkable elevation in the level of serum S100β in TAA rats group. On the other hand, induction of hepatic encephalopathy caused a significant (p<0.05) decrease in albumin and total protein levels than those in control rats. When HE rats group was treated with lactulose or taurine and their mixture a considerable amelioration effects in all previous studied parameters were pronounced dependent on certain mechanisms.

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Management of Covert Hepatic Encephalopathy

Cited by 11 publications

References 73 publications

Validation of EncephalApp, Smartphone-Based Stroop Test, for the Diagnosis of Covert Hepatic Encephalopathy

Validation of EncephalApp, Smartphone-Based Stroop Test, for the Diagnosis of Covert Hepatic Encephalopathy

Cerebral Hemodynamics and Cognitive Function in Cirrhotic Patients with Hepatic Encephalopathy

Biochemical and Pathophysiological Aspects of the Treatment of Hepatic Encephalopathy in Rats

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