Clinical—Liver, Pancreas, and Biliary TractPersistence of Cognitive Impairment After Resolution of Overt Hepatic Encephalopathy
Section snippets
Patients and Methods
Subjects for this study included patients with an established diagnosis of hepatic cirrhosis, based on histology or clinical criteria (physical examination and laboratory and imaging findings), who were seen and evaluated in our outpatient clinics in the Medical College of Wisconsin, Virginia Commonwealth University Medical Center, and McGuire VA Medical Center. Patients with prior overt HE were included only if they were receiving appropriate treatment with lactulose and/or rifaximin, were
Results
Cross-sectional study part A: Of the 226 patients included, 54 had prior overt HE and 172 did not. Patients without prior overt HE were divided on the basis of the psychometric tests into normal and minimal HE; 52 were normal, and the remaining 120 were minimal HE. The demographic and cirrhosis details are displayed in Table 1. The 54 patients with prior overt HE were currently adherent on lactulose (defined by mini-mental score >25, corroboration of lactulose use by caregivers, and by at least
Discussion
The SONIC forms a continuum that spans the range from normal cognitive function to minimal HE to overt HE.1, 13 Both minimal and overt hepatic encephalopathy are generally considered to be fully reversible with treatment.15 However, a variety of lines of evidence suggests that the metabolic derangement caused by ammonia and other neurotoxins in cirrhosis may result in neurologic injury that can be persistent and possibly permanent.5, 16, 17, 18, 19 In autopsy series, brains of patients dying in
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Conflicts of interest The authors disclose the following: Dr Bajaj is a consultant for and receives independent grant support from Salix and Ocera. Dr Sanyal is a consultant for Salix Pharmaceuticals. The remaining authors disclose no conflicts.
Funding Supported in part by the American College of Gastroenterology Junior Faculty Development Award, and by clinical research center grants MO1-RR00065 and MO1-RR00058, NCRR, and NIH (awarded to J.S.B.).