P.09.10 CIRRHOTIC PATIENTS WITH MINIMAL HEPATIC ENCEPHALOPATHY PRESENT INCREASED CEREBRAL VASCULAR RESISTANCE, WHICH REMAINS UNCHANGED AFTER MEDICAL TREATMENT

Abstract Minimal hepatic encephalopathy (MHE) is a subclinical complication of liver cirrhosis with a relevant social impact. Thus, there is urgent need to implement easy to use diagnostic tools for the early identification of affected patients. The aim of this study was to investigate cerebral blood flow, systemic hemodynamics as well as endothelial function of cirrhotic patients with MHE, and to verify their change after treatment with rifaximin. Fifty cirrhotic patients with or without MHE and an equal number of healthy controls underwent transcranial Doppler ultrasound (TCD), abdominal Doppler ultrasound (US), and measurement of flow mediated dilation (FMD). In cirrhotic patients diagnosed with MHE receiving rifaximin, the tests were repeated at the end of treatment. Middle (MCA) and posterior (PCA) cerebral artery resistive (RI) and pulsatility (PI) indices were higher in cirrhotic patients than controls, as well as renal and splenic artery RI. Conversely, FMD was reduced. MCA-RI and PI were even higher in cirrhotic patients with MHE compared to those without; a MCA-RI cut-off of 0.65 showed an accuracy of 74% in discriminating the presence of MHE, with 65% sensitivity and 76% specificity. Rifaximin treatment showed no efficacy in the modulation of cerebral vascular flow. In conclusion, cirrhotic patients with MHE have significantly increased cerebral vascular resistances that are not improved by rifaximin treatment. MCA-RI measurement has a good accuracy for the diagnosis of MHE and can be useful for the early identification of this harmful complication of liver cirrhosis.

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Faculty Opinions recommendation of Lactulose reduces bacterial DNA translocation, which worsens neurocognitive shape in cirrhotic patients with minimal hepatic encephalopathy.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.726490324.793535965 ◽

2017 ◽

Author(s):

Sharon DeMorrow

Keyword(s):

Hepatic Encephalopathy ◽

Minimal Hepatic Encephalopathy ◽

Dna Translocation ◽

Bacterial Dna ◽

Cirrhotic Patients

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Patients with Minimal Hepatic Encephalopathy Show Altered Thermal Sensitivity and Autonomic Function

Journal of Clinical Medicine ◽

10.3390/jcm10020239 ◽

2021 ◽

Vol 10 (2) ◽

pp. 239

Author(s):

Dalia Rega ◽

Mika Aiko ◽

Nicolás Peñaranda ◽

Amparo Urios ◽

Juan-José Gallego ◽

...

Keyword(s):

Nervous System ◽

Hepatic Encephalopathy ◽

Quantitative Sensory Testing ◽

Autonomic Function ◽

Thermal Sensitivity ◽

Somatosensory System ◽

Minimal Hepatic Encephalopathy ◽

Heat Pain ◽

Sensory Testing ◽

Cirrhotic Patients

Cirrhotic patients may experience alterations in the peripheral nervous system and in somatosensory perception. Impairment of the somatosensory system could contribute to cognitive and motor alterations characteristic of minimal hepatic encephalopathy (MHE), which affects up to 40% of cirrhotic patients. We assessed the relationship between MHE and alterations in thermal, vibration, and/or heat pain sensitivity in 58 cirrhotic patients (38 without and 20 with MHE according to Psychometric Hepatic Encephalopathy Score) and 39 controls. All participants underwent attention and coordination tests, a nerve conduction study, autonomic function testing, and evaluation of sensory thresholds (vibration, cooling, and heat pain detection) by electromyography and quantitative sensory testing. The detection thresholds for cold and heat pain on the foot were higher in patients with, than those without MHE. This hyposensitivity was correlated with attention deficits. Reaction times in the foot were longer in patients with, than without MHE. Patients with normal sural nerve amplitude showed altered thermal sensitivity and autonomic function, with stronger alterations in patients with, than in those without MHE. MHE patients show a general decrease in cognitive and sensory abilities. Small fibers of the autonomic nervous system and thermal sensitivity are altered early on in MHE, before large sensory fibers. Quantitative sensory testing could be used as a marker of MHE.

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Normalisation of the psychometric encephalopathy score within the Cameroonian population

BMC Gastroenterology ◽

10.1186/s12876-021-01858-7 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Larissa Pessidjo Djomatcho ◽

Mathurin Pierre Kowo ◽

Antonin Ndjitoyap Ndam ◽

Sylvain Raoul Simeni Njonnou ◽

Gabin Ulrich Kenfack ◽

...

Keyword(s):

Hepatic Encephalopathy ◽

Healthy Volunteers ◽

Clinical Signs ◽

Minimal Hepatic Encephalopathy ◽

Education Level ◽

Multicentric Study ◽

Tracing Test ◽

Cirrhotic Patients ◽

The Mean ◽

Number Connection Test

Abstract Background Minimal hepatic encephalopathy (MHE) is the presence of neuropsychological abnormalities detectable by psychometric tests. Psychometric Hepatic Encephalopathy Score (PHES) is a gold standard test for the early diagnosis of MHE in cirrhotic patients. The aim of this study was to standardize the PHES in a healthy Cameroonian population and to evaluate the prevalence of MHE among cirrhotic patients. Methods This was a prospective, multicentric study from 1 December 2018 to 31 July 2019 in two groups: healthy volunteers and cirrhotic patients without clinical signs of hepatic encephalopathy. The results of the number connection test-A, number connection test-B, serial dotting test, line tracing test were expressed in seconds and those of the digit symbol test in points. Results A total of 102 healthy volunteers (54 men, 48 women) and 50 cirrhotic patients (29 men, 31 women) were included. The mean age was 38.1 ± 12.55 years in healthy volunteers and 49.3 ± 15.6 years in cirrhotic patients. The mean years of education level was 11.63 ± 4.20 years in healthy volunteers and 9.62 ± 3.9 years in cirrhotic patients. The PHES of the healthy volunteer group was − 0.08 ± 1.28 and the cut-off between normal and pathological values was set at − 3 points. PHES of the cirrhotic patients was − 7.66 ± 5.62 points and significantly lower than that of volunteers (p < 0.001). Prevalence of MHE was 74% among cirrhotic patients. Age and education level were associated with MHE. Conclusion PHES cut-off value in Cameroonians is − 3, with MHE prevalence of 74% among cirrhotic patients.

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