Subclinical Hepatic Encephalopathy

Quero, Juan C.; Schalm, Solko W.

doi:10.1055/s-2007-1007244

Cited by 110 publications

(62 citation statements)

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“…23,39 The prevalence of MHE has been reported to vary between 30% and 84% in patients with liver cirrhosis. 40 The major difficulty in diagnosing MHE has been not having a precisely defined gold standard for determining this disorder. The large variation in prevalence found in different studies is related to the criteria used to diagnose MHE and to the patient populations studied.…”

Section: Discussionmentioning

confidence: 99%

Lactulose improves cognitive functions and health-related quality of life in patients with cirrhosis who have minimal hepatic encephalopathy

et al. 2007

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Minimal hepatic encephalopathy (MHE) has a negative effect on patients' daily functioning. Thus far, no study has investigated the effect of treatment-related improvement in cognitive functions on health-related quality of life (HRQOL). We measured psychometric performance by number and figure connection tests parts A and B, picture completion, and block design tests and HRQOL by the Sickness Impact Profile (SIP) of 90 patients with cirrhosis on inclusion into the study and 3 months later. A Z score less than ؊2 on the neuropsychological (NP) tests was considered abnormal. Sixty-one (67.7%) patients had MHE. They were randomly assigned in a 1:1 ratio to receive treatment (lactulose) for 3 months (n ‫؍‬ 31) or no treatment (n ‫؍‬ 30) in a nonblinded design. H epatic encephalopathy (HE) is a spectrum of neuropsychiatric abnormalities seen in patients with liver dysfunction diagnosed after exclusion of other known brain diseases. The Working Party at the 11th World Congress of Gastroenterology, Vienna, under the Organization Mondiale de Gastroentrologie proposed a multiaxial definition of HE that defined both the type of hepatic abnormality (type A, B, or C) and the duration and characteristics of neurological manifestations (episodic, persistent, or minimal HE) in chronic liver disease. 1 HE has been considered a continuous dimension that could be measured with 1 index to summarize several neurological domains, such as cognition, emotion, behavior, and biologic rhythms. Minimal hepatic encephalopathy (MHE) represents a portion of this dimension and is the mildest form of HE. Whereas patients with HE have impaired intellectual functioning, personality changes, altered level of consciousness, and neuromuscular dysfunction, patients with MHE have no recognizable clinical symptoms of HE but do have mild cognitive and psychomotor deficits. In the absence of a "gold standard" for determining MHE, neuropsychological (NP) and neurophysiological methods have been the most trusted and widely used tests to diagnose this condition. 1,2 MHE is considered clinically relevant for at least 3 reasons. First, it impairs patients' daily functioning and

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Section: Discussionmentioning

confidence: 99%

Lactulose improves cognitive functions and health-related quality of life in patients with cirrhosis who have minimal hepatic encephalopathy

et al. 2007

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“…14 The prevalence of MHE in patients with cirrhosis who do not have the evidence of overt HE is high and has been reported to vary between 30% and 84%. 2,10,15 Large variability in these studies were due to different diagnostic criteria used and population studied. Prevalence of MHE in our population varies between 48% and 67.7% as shown by our previous studies using psychometric tests.…”

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confidence: 99%

Minimal Hepatic Encephalopathy Impairs Quality of Life

Agrawal

Umapathy

Dhiman

2015

Journal of Clinical and Experimental Hepatology

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Minimal hepatic encephalopathy (MHE) is the mildest form of the spectrum of neurocognitive impairment in cirrhosis. It is a frequent occurrence in patients of cirrhosis and is detectable only by specialized neurocognitive testing. MHE is a clinically significant disorder which impairs daily functioning, driving performance, work capability and learning ability. It also predisposes to the development of overt hepatic encephalopathy, increased falls and increased mortality. This results in impaired quality of life for the patient as well as significant social and economic burden for health providers and care givers. Early detection and treatment of MHE with ammonia lowering therapy can reverse MHE and improve quality of life. ( J CLIN EXP HEPATOL 2015;5:S42-S48) H epatic encephalopathy (HE) is a neurocognitive disorder in which brain function is impaired and is associated with both acute and chronic liver dysfunction. 1 It is a major complication that develops in some form and at some stage in a majority of patients with liver cirrhosis. Minimal HE (MHE) is the mildest form of spectrum of HE which is characterized by subtle cognitive and psychomotor deficits in the absence of recognizable clinical symptoms of HE. 2 It occurs in patients with liver dysfunction and/or portosystemic shunts. In MHE, neurocognitive abnormalities primarily affect attention, speed of information processing, executive control, motor ability and coordination in an individual. 3 In 1970, Zeegen et al 4 first described this condition when they discovered that 38% of patients who had undergone portal decompression surgery scored abnormal in Reitan trail making test (number connection test). Eight years later, the term subclinical HE 5 was introduced to describe these patients. Since then, this condition was described under various names like early HE, latent HE, subclinical HE and finally minimal HE. The latest classification combines MHE and grade 1 HE into covert HE while higher grades are classified as overt HE, thus simplifying the clinical schema so that HE can be uniformly diagnosed. 6 Covert HE means that the mental defect is not detectable by the clinician using conventional testing and is not noticeable to the patient. However, it is significant because these patients usually have neuropsychiatric and neurophysiological abnormalities on advanced testing which are not enough to cause disorientation or asterixis. MHE is regarded as a preclinical stage of HE and ammonia and systemic inflammation plays an important role in its pathogenesis similar to HE. Ammonia lowering therapies were used in the treatment of MHE and found to be effective.MHE is clinically significant as it impairs daily functioning, health related quality of life (HRQOL) and driving skills, predicts the development of overt HE and is associated with poor survival. 7-11 Overt HE develops in >50% of MHE patients within three years. 10 These patients pose a significant burden to their care givers depending on the severity of cognitive dysfunction. 2,12 Considering all ...

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“…The prevalence of MHE in other studies varies between 30% and 84% in cirrohosis. [12][13][14] This wide variation in the prevalence is due to several factors which includes 1) the criteria for diagnosis, 2) the population studied including the age, education 3) the severity of liver dysfunction, 4) alcoholic etiologyduration and severity and 5) presence of porto-systemic shunts. 15 Study of cordoba et al showed that neurocognitive impairment was observed even in patients with normal liver function due to presence of spontaneous porto-systemic shunts.…”

Section: Discussionmentioning

confidence: 99%

Minim Al Hepatic Encephalopathy in Al Coholic Cirrhosis

Anbuselvan¹,

K²,

Subashini³

et al. 2015

jemds

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BACKGROUND: Minimal hepatic Encephalopathy (MHE) has severe and important health implications which affects the quality of life as well as the survival of patients with liver disease. Psychometric hepatic encephalopathy score (PHES) has been validated for diagnosis of MHE. AIM OF THE STUDY:To detect the prevalence of minimal hepatic encephalopathy (MHE) in alcoholic cirrhosis patients and to compare the patterns of alcohol consumption in patients with MHE to those without MHE (NON-MHE). SETTINGS AND DESIGN: The study was conducted in Chettinad Hospital and Research Institute, Kelambakkam, a 1000 bedded academic medical centre in South India. This was a prospective observational study. MATERIALS AND METHODS: 25 alcoholic cirrhotic patients without overt hepatic encephalopathy and 20 patients who are alcoholics without any liver disease were given the five tests of PHES (Number connection test A (NCT-A), Figure connection test (FCT), Line Tracing Test (LTT), Circle Dotting Test (CDT) and Digit Symbol Test (DST)) in a quiet well lit room. Individual performance test values more than 1 S.D from the mean were considered abnormal. Based on the nomogram of healthy volunteers, the patients were classified as having MHE when they had impaired performance in ≥2 tests. RESULTS: There was no significant difference in the baseline characteristics between the two groups. In liver cirrhosis patients, MHE was diagnosed in 7 patients (28%). In NCT-A 28% (n=7) did abnormally, in FCT 16% (n=4), in LTT, CDT and DST 24% (n=6), 12% (n=3), 24% (n=6) respectively had impaired performance. NCT-A and LTT showed statistically significant difference between the study group. Hence these 2 tests were considered to have high sensitivity for screening of MHE (p-0.003, p-0.004). The proportion of patients with MHE increased as the duration of alcohol consumption increased. 73.3% of those with MHE had more than 10 years of alcohol consumption. CONCLUSION: The prevalence of MHE in alcoholic cirrhosis in our population was 28% which is close to that reported from other populations. Age and education had major influence on the overall test performance and it needs to be taken into consideration while interpretation of test results. The greater the duration of alcohol intake there was an increase in the occurrence of Minimal hepatic encephalopathy. Those even with harmful drinking pattern for longer duration are prone to develop DCLD and complications of hepatic encephalopathy.

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Subclinical Hepatic Encephalopathy

Cited by 110 publications

References 3 publications

Lactulose improves cognitive functions and health-related quality of life in patients with cirrhosis who have minimal hepatic encephalopathy

Lactulose improves cognitive functions and health-related quality of life in patients with cirrhosis who have minimal hepatic encephalopathy

Minimal Hepatic Encephalopathy Impairs Quality of Life

Minim Al Hepatic Encephalopathy in Al Coholic Cirrhosis

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