Encefalopatía hepática: historia natural de la enfermedad, nueva clasificación e impacto en la calidad de vida

Hepatic Encephalopathy (HE) is a term including a wide range of neuropsychiatric changes, secondary to chronic hepatic damage. In Mexico, there is scarce epidemiological data about cirrhosis; thus, its prevalence is unknown. In 2000, cirrhosis was the fifth cause of death and in 2011 INEGI reported that digestive diseases were the fifth most common cause of mortality: in 2013, cirrhosis was the fourth cause of death. It has been estimated that by 2020 there will be 1,496,000 patients with cirrhosis, and by 2050 the figure will rise to 1,866,000. Therefore, an analysis was carried out in order to propose the new classification as a tool to calculate the epidemiology of hepatic encephalopathy and cirrhosis in Mexico, as well as to evaluate its impact on quality of life. Based on the historical descriptions of the HE, the natural history of the disease was reviewed focusing on the classifications. The results showed that the minimal hepatic encephalopathy requires, like any other subclinical hepatic encephalopathy, a meticulous clinical testing. Regarding the quality of life, several researchers have associated improvement with the treatment for hepatic encephalopathy. The authors conclude that hepatic encephalopathy must be classified according to the underlying etiology, clinical severity, course of time, and triggering factors analyzed in the latest international guidelines.