Advances in the evaluation and management of minimal hepatic encephalopathy

Current Gastroenterology Reports

Volumn 13, Issue 1, 2011, Pages 26-33

  Montgomery, Jennifer Y ^a   Bajaj, Jasmohan S ^a  

^a VIRGINIA COMMONWEALTH UNIVERSITY   (United States)

Author keywords

Burden; Cirrhosis; Complications; Critical flicker frequency; Daily functioning; Earning capacity; Employment; Inhibitory control test; Lactulose; Minimal hepatic encephalopathy; Overt hepatic encephalopathy; Probiotics; Progression; Psychometric Hepatic Encephalopathy Score (PHES); Quality of life; Randomized controlled trial; Rifaximin; Spectrum of neurocognitive changes in cirrhosis (SONIC); Survival; Synbiotics; Traffic accidents

Indexed keywords

4 PHENYLBUTYRIC ACID; ACETYLCYSTEINE; ALBUMIN; AMMONIA; BROMOCRIPTINE; FLUMAZENIL; LACTULOSE; N METHYL DEXTRO ASPARTIC ACID RECEPTOR BLOCKING AGENT; NEOMYCIN; ORNITHINE ASPARTATE; PLACEBO; PROBIOTIC AGENT; PROSTAGLANDIN SYNTHASE INHIBITOR; RIFAXIMIN; SYNBIOTIC AGENT;

AMMONIA BLOOD LEVEL; ARTICLE; CLINICAL EVALUATION; CLINICAL FEATURE; DIAGNOSTIC ACCURACY; DISEASE SEVERITY; DRIVING ABILITY; DRUG EFFICACY; DRUG SAFETY; HEPATIC ENCEPHALOPATHY; HUMAN; HYPERAMMONEMIA; INDUCED HYPOTHERMIA; LIVER CIRRHOSIS; LONG TERM CARE; MEDICAL HISTORY; NEUROIMAGING; NEUROPSYCHOLOGICAL TEST; NONHUMAN; OXIDATIVE STRESS; PATHOGENESIS; PATIENT COMPLIANCE; PSYCHOMETRY; PSYCHOMOTOR DISORDER; QUALITY OF LIFE; SENSITIVITY AND SPECIFICITY; SURVIVAL RATE; TRAFFIC ACCIDENT; TREATMENT DURATION; TREATMENT PLANNING;

HEPATIC ENCEPHALOPATHY; HUMANS; LIVER CIRRHOSIS; MAGNETIC RESONANCE IMAGING; MAGNETIC RESONANCE SPECTROSCOPY; NEUROPSYCHOLOGICAL TESTS; QUALITY OF LIFE;

EID: 79551524286     PISSN: 15228037     EISSN: None     Source Type: Journal    
DOI: 10.1007/s11894-010-0150-z     Document Type: Article

References (55)

1. JS Bajaj JB Wade AJ Sanyal 2009 Spectrum of neurocognitive impairment in cirrhosis: implications for the assessment of hepatic encephalopathy Hepatology 50 2014 2021 10.1002/hep.23216 19787808 This article provides a detailed analysis of the available testing strategies for MHE and the need to treat this as a spectrum of disease.
2. P Ferenci A Lockwood K Mullen, et al. 2002 Hepatic encephalopathy- definition, nomenclature, diagnosis, and quantification: final report of the working party at the 11th World Congresses of Gastroenterology, Vienna, 1998 Hepatology 35 716 721 10.1053/jhep.2002.31250 11870389 (Pubitemid 34183979)
3. KD Mullen 2007 Review of the final report of the 1998 Working Party on definition, nomenclature and diagnosis of hepatic encephalopathy Aliment Pharmacol Ther 25 Suppl 1 11 16 10.1111/j.1746-6342.2006.03216.x 17295847 (Pubitemid 46148240)
4. C •Randolph R Hilsabeck A Kato, et al. 2009 Neuropsychological assessment of hepatic encephalopathy: ISHEN practice guidelines Liver Int 29 629 635 10.1111/j.1478-3231.2009.02009.x 19302444 This review provides a consensus for neuropsychological assessment in patients at risk for MHE.
5. RK Dhiman VA Saraswat BK Sharma, et al. 2010 Indian National Association for Study of the Liver: Minimal hepatic encephalopathy: consensus statement of a working party of the Indian National Association for Study of the Liver J Gastroenterol Hepatol 25 1029 1041 10.1111/j.1440-1746.2010.06318.x 20594216
6. P Sharma 2009 Minimal hepatic encephalopathy J Assoc Physicians India 57 760 763 20329443
7. RK Dhiman YK Chawla 2009 Minimal hepatic encephalopathy Indian J Gastroenterol 28 5 16 10.1007/s12664-009-0003-6 19529896
8. P Sharma BC Sharma 2010 Predictors of minimal hepatic encephalopathy in patients with cirrhosis Saudi J Gastroenterol 16 181 187 10.4103/1319-3767.65189 20616413
9. JS Bajaj 2008 Minimal hepatic encephalopathy matters in daily life World J Gastroenterol 14 3609 3615 10.3748/wjg.14.3609 18595126
10. P Sharma BC Sharma V Puri SK Sarin 2009 Natural history of minimal hepatic encephalopathy in patients with extrahepatic portal vein obstruction Am J Gastroenterol 104 885 890 10.1038/ajg.2009.84 19293781
11. M Groeneweg JC Quero I De Bruijn, et al. 1998 Subclinical hepatic encephalopathy impairs daily functioning Hepatology 28 45 49 1:STN:280:DyaK1czhvFWktQ%3D%3D 10.1002/hep.510280108 9657095 (Pubitemid 28299984)
12. M Groeneweg W Moerland JC Quero, et al. 2000 Screening of subclinical hepatic encephalopathy J Hepatol 32 748 753 1:STN:280:DC%2BD3cvnt12guw%3D%3D 10.1016/S0168-8278(00)80243-3 10845661 (Pubitemid 30262734)
13. YQ Zhou SY Chen LD Jiang, et al. 2009 Development and evaluation of the quality of life instrument in chronic liver disease patients with minimal hepatic encephalopathy J Gastroenterol Hepatol 24 408 415 10.1111/j.1440-1746. 2008.05678.x 19054261
14. Y Kim G Park M Lee JH Lee 2009 Impairment of driving ability and neuropsychological function in patients with MHE disease Cyberpsychol Behav 12 433 436 10.1089/cpb.2008.0242 19366322
15. C Wein H Koch B Popp, et al. 2004 Minimal hepatic encephalopathy impairs fitness to drive Hepatology 39 739 745 10.1002/hep.20095 14999692 (Pubitemid 38337653)
16. JS Bajaj M Hafeezullah Y Zadvornova, et al. 2009 The effect of fatigue on driving skills in patients with hepatic encephalopathy Am J Gastroenterol 104 898 905 10.1038/ajg.2009.7 19277025
17. JS Bajaj K Saeian CM Schubert, et al. 2009 Minimal hepatic encephalopathy is associated with motor vehicle crashes: the reality beyond the driving test Hepatology 50 1175 1183 10.1002/hep.23128 19670416 This article provides actual translation from driving tests to retrospective and prospective driving offenses in MHE patients.
18. G Kircheis A Knoche N Hilger, et al. 2009 Hepatic encephalopathy and fitness to drive Gastroenterology 137 1706 1715 10.1053/j.gastro.2009.08.003 19686744
19. KD Mullen 2007 Pathogenesis, clinical manifestation, and diagnosis of hepatic encephalopathy Semin Liver Dis 27 3 9 10.1055/s-2007-984573 (Pubitemid 47311540)
20. AS Seyan RD Hughes DL Shawcross 2010 Changing face of hepatic encephalopathy: role of inflammation and oxidative stress World J Gastroenterol 16 3347 3357 10.3748/wjg.v16.i27.3347 20632436 This article provides a comprehensive review of the pathophysiologic mechanisms of ammonia and oxidative stress in the development of MHE.
21. KD Mullen P Ferenci NM Bass, et al. 2007 An algorithm for the management of hepatic encephalopathy Semin Liver Dis 27 32 48 10.1055/s-2007-984576 (Pubitemid 47311544)
22. B Gorg N Qvartskhava HJ Bidmon, et al. 2010 Oxidative stress markers in the brain of patients with cirrhosis and hepatic encephalopathy Hepatology 52 256 265 20583283
23. DL Shawcross NA Davies R Williams R Jalan 2004 System inflammatory response exacerbates the neuropsychological effects of induced hyperammonemia in cirrhosis J Hepatol 40 247 254 1:CAS:528:DC%2BD2cXltVCitw%3D%3D 10.1016/j.jhep.2003.10.016 14739095 (Pubitemid 38115829)
24. D Shawcross R Jalan 2005 The pathophysiologic basis of hepatic encephalopathy: central role of ammonia and inflammation Cell Mol Life Sci 62 2295 2304 1:CAS:528:DC%2BD2MXht1ShsbrK 10.1007/s00018-005-5089-0 16158192 (Pubitemid 41500545)
25. DL Shawcross G Wright SW Olde Damink R Jalan 2007 Role of ammonia and inflammation in minimal hepatic encephalopathy Metab Brain Dis 22 125 138 1:CAS:528:DC%2BD2sXisVejtr4%3D 10.1007/s11011-006-9042-1 17260161 (Pubitemid 46354829)
26. C Montoliu B Piedrafita MA Serra, et al. 2009 IL-6 and IL-18 in blood may discriminate cirrhotic patients with and without minimal hepatic encephalopathy J Clin Gastroenterol 43 272 279 1:CAS:528:DC%2BD1MXit1Cgsbg%3D 10.1097/MCG.0b013e31815e7f58 18562979
27. Q Liu ZP Duan DK Ha, et al. 2004 Synbiotic modulation of gut flora: effect on minimal hepatic encephalopathy in patients with cirrhosis Hepatology 39 1441 1449 10.1002/hep.20194 15122774 (Pubitemid 38569067)
28. Gupta A, Dhiman RK, Kumari S, et al.: Role of small intestinal bacterial overgrowth and delayed gastrointestinal transit time in cirrhotic patients with minimal hepatic encephalopathy. J Hepatol 2010 (Epub ahead of print).
29. • Jimenez B, Montoliu C, Macintyre DA, et al.: The serum metabolic signature of minimal hepatic encephalopathy by H-nuclear magnetic resonance. J Proteome Res 2010 (Epub ahead of print). The authors provide a metabolomic analysis of serum, which offers new insight into the disease process.
30. M Romero-Gómez M Jover JA Del Campo, et al. 2010 Variations in the promoter region of the glutaminase gene and the development of hepatic encephalopathy in patients with cirrhosis: a cohort study Ann Intern Med 153 281 288 20820037 Genetic single-nucleotide polymorphism analysis in patients with cirrhosis that predicts overt HE.
31. JS Bajaj M Hafeezullah J Franco, et al. 2008 Inhibitory control test for the diagnosis of minimal hepatic encephalopathy Gastroenterology 135 1591 1600 10.1053/j.gastro.2008.07.021 18723018
32. CA Stewart FT Enders N Schneider, et al. 2010 Development of a three-factor neuropsychological approach for detecting minimal hepatic encephalopathy Liver Int 30 841 849 10.1111/j.1478-3231.2010.02246.x 20412441
33. JH Sorrell BJ Zolnikov A Sharma I Jinnai 2006 Cognitive impairment in people diagnosed with end-stage liver disease evaluated for liver transplantation Psychiatry Clin Neurosci 60 174 181 10.1111/j.1440-1819.2006. 01483.x 16594941
34. P Amodio F Campagna S Olianas, et al. 2008 Detection of minimal hepatic encephalopathy: normalization and optimization of the Psychometric Hepatic Encephalopathy Score. A neuropsychological and quantified EEG study J Hepatol 49 346 353 10.1016/j.jhep.2008.04.022 18602716
35. P Sharma BC Sharma V Puri SK Sarin 2007 Critical flicker frequency: diagnostic tool for minimal hepatic encephalopathy J Hepatol 47 67 73 1:STN:280:DC%2BD2szjtVehtg%3D%3D 10.1016/j.jhep.2007.02.022 17459511 (Pubitemid 46830721)
36. P Sharma BC Sharma SK Sarin 2010 Critical flicker frequency for diagnosis and assessment of recovery from minimal hepatic encephalopathy in patients with cirrhosis Hepatobiliary Pancreat Dis Int 9 27 32 1:CAS:528:DC%2BC3cXjtVSktLs%3D 20133225
37. M Romero-Gomez J Cordoba R Jover, et al. 2007 Value of the critical flicker frequency in patients with minimal hepatic encephalopathy Hepatology 45 879 885 10.1002/hep.21586 17393525 (Pubitemid 46631556)
38. G Kircheis M Wettstein L Timmermann, et al. 2002 Critical flicker frequency for quantification of low-grade hepatic encephalopathy Hepatology 35 357 366 10.1053/jhep.2002.30957 11826409 (Pubitemid 34106375)
39. RK Dhiman R Kurmi KK Thumburu, et al. 2010 Diagnosis and prognostic significance of minimal hepatic encephalopathy in patients with cirrhosis of liver Dig Dis Sci 55 2381 2390 10.1007/s10620-010-1249-7 20508990 This article shows that abnormal psychometric testing can adversely affect survival in patients with cirrhosis.
40. P Amodio L Ridola S Schiff, et al. 2010 Improving the inhibitory control task to detect minimal hepatic encephalopathy Gastroenterology 139 510 518 10.1053/j.gastro.2010.04.057 20470775
41. M Butz L Timmermann M Braun, et al. 2010 Motor impairment in liver cirrhosis without and with minimal hepatic encephalopathy Acta Neurol Scand 122 27 35 1:STN:280:DC%2BC3cnksVOhug%3D%3D 10.1111/j.1600-0404.2009.01246.x 20003084
42. A Singhal R Nagarajan CH Hinkin, et al. 2010 Two-dimensional MR spectroscopy of minimal hepatic encephalopathy and neuropsychological correlates in vivo J Magn Reson Imaging 32 35 43 10.1002/jmri.22216 20578008
43. M Ortiz C Jacas J Cordoba 2005 Minimal hepatic encephalopathy: diagnosis, clinical significance and recommendations J Hepatol 42 S45 S53 10.1016/j.jhep.2004.11.028 15777572 (Pubitemid 40364603)
44. HH Tan GH Lee KT Thia, et al. 2009 Minimal hepatic encephalopathy runs a fluctuating course: results from a three-year prospective cohort follow-up study Singapore Med J 50 255 260 1:STN:280:DC%2BD1M3msVOgtg%3D%3D 19352567
45. IJC Hartmann M Groeneweg JC Quero, et al. 2000 The prognostic significance of subclinical hepatic encephalopathy Am J Gastroenterol 95 2029 2034 1:STN:280:DC%2BD3cvhs1aqsQ%3D%3D 10.1111/j.1572-0241.2000.02265.x 10950053
46. M Holecek 2010 Three targets of branched-chain amino acid supplementation in the treatment of liver disease Nutrition 26 482 490 1:CAS:528: DC%2BC3cXksFGmsLk%3D 10.1016/j.nut.2009.06.027 20071143
47. J Abdo-Francis J Perez-Hernandez A Hinojosa-Ruiz J Hernandez-Vasquez 2010 Use of L-ornithine L-aspartate (LOLA) reduces time of hospital stay in patients with hepatic encephalopathy [in Spanish] Rev Gastroenterol Mex 75 135 141 20615780
48. M Schmid M Peck-Radosavljevic F Konig, et al. 2010 A double-blind, randomized, placebo-controlled trial of intravenous L-ornithine-L-aspartate on postural control in patients with cirrhosis Liver Int 30 574 582 1:CAS:528:DC%2BC3cXkt1amu7w%3D 10.1111/j.1478-3231.2010.02213.x 20456040
49. JS Bajaj K Saeian KM Christensen, et al. 2008 Probiotic yogurt for the treatment of minimal hepatic encephalopathy Am J Gastroenterol 103 1707 1715 10.1111/j.1572-0241.2008.01861.x 18691193
50. NM Bass KD Mullen A Sanyal, et al. 2010 Rifaximin treatment in hepatic encephalopathy N Engl J Med 25 362 1071 1081 10.1056/NEJMoa0907893 Multicenter, randomized, placebo-controlled trial of rifaximin in patients with overt HE in which rifaximin reduced the recurrent episodes and hospitalizations for overt HE.
51. JS Bajaj 2010 Review article: the modern management of hepatic encephalopathy Aliment Pharmacol Ther 31 537 547 1:CAS:528:DC%2BC3cXjsFeqtrw%3D 10.1111/j.1365-2036.2009.04211.x 20002027
52. BM McGuire IA Zupanets ME Lowe, et al. 2010 Pharmacology and safety of glycerol phenylbutyrate in healthy adults and adults with cirrhosis Hepatology 51 2077 2085 1:CAS:528:DC%2BC3cXnslyqt7o%3D 20512995
53. S Prasad RK Dhiman A Duseja, et al. 2007 Lactulose improves cognitive functions and health-related quality of life in patients with cirrhosis who have minimal hepatic encephalopathy Hepatology 45 549 559 10.1002/hep.21533 17326150 (Pubitemid 46450607)
54. S Sidhu O Goyal BP Mishra, et al. 2010 Rifaximin improves cognitive functions and health-related quality of life in patients with minimal hepatic encephalopathy: a prospective, randomized, double-blind, placebo-controlled trial (the RIME Trial) [abstract] Gastroenterology 139 e18 e19 10.1053/j.gastro.2010.05.069
55. Bajaj JS, Heuman DM, Wade JB, et al.: Rifaximin improves driving simulator performance in a randomized trial of patients with minimal hepatic encephalopathy. Gastroenterology 2010. doi: 10.1053/j.gastro.2010.08.061. This article describes a randomized, controlled trial showing rifaximin improved the driving capabilities of patients with MHE.