Hepatic encephalopathy subclinical

Tab. 15.5 Diagram of the stages of hepatic encephalopathy (subclinical and latent forms and manifestation I-IV) as well as their respective symptomatology...

On the basis of log bacterial survival rates, the antibacterial activity of rifaximin was greater than that of paromomycin against Enterococcus spp., anaerobic cocci, Bac-terioides spp. and Clostridium spp. isolated in fecal samples from 20 patients with subclinical hepatic encephalopathy (fig. 4) [81]. On the other hand, E. coli dead Klebsiella spp. appeared more susceptible to paromomycin while both antibiotics showed equal potency against Proteus spp. [81]. Here again it should be pointed out that stool concentrations of rifaximin are 250-500 times higher than the MIC90 values [71], which makes the in vitro differences of activity between this and other antimicrobials meaningless from a clinical standpoint. 

In suspected subclinical hepatic encephalopathy, psychometric tests are extremely important for the diagnosis and cannot be substituted by other examination procedures (e.g. anamnesis, inspection, laboratory analysis, imaging). 

Guedon, C., Ducrotte, R, Weber, J., Hannequin, D., Colin, R., Denis, R, Lerebours, E. Detection of subclinical hepatic encephalopathy with pattern reversal evoked potentials and reaction time to light can malnutrition alter the results Eur. J. Gastroenterol. Hepatol. 1993 5 549-554... 

Mehndiratta, M.M., Sood, G.K., Sarin, S.K., Gupta, M. Comparative evaluation of visual, somatosensory, and auditory evoked potentials in the detection of subclinical hepatic encephalopathy in patients with nonalcoholic cirrhosis. Amer. J. Gastroenterol. 1990 85 799-803... 

Rikkers, L., Jenko, P., Rudman, D., Freides, D. Subclinical hepatic encephalopathy detection, prevalence and relationship to nitrogen metabolism. Gastroenterology 1978 75 462-469... 

Ross, B.D., Danielsen, E.R., Blund, S. Proton magnetic resonance spectroscopy the new gold standard for diagnosis of clinical and subclinical hepatic encephalopathy. Dig. Dis. 1996 14 30—39... 

Saxena, N., Bhatia, M., Joshi, Y.K., Garg, P.K., Tandon, R.K. Auditory P 300 event-related potentials and number connection test for subclinical hepatic encephalopathy in patients with cirrhosis of the liver a follow-up study. J. Gastroenterol. Hepatol. 2001 16 322—327... 

Shiota, T. Quantitative psychometric testing and subclinical hepatic encephalopathy-comparative study between encephalopathic and non-en-cephalopathic patients with liver cirrhosis. Acta Med. Okayama 1984 38 193-205... 

While hepatic encephalopathy is nearly always found in acute liver failure, it can only be expected in some 25-40% of patients with a portosystemic shunt. When these two preconditions coincide, as in the case of liver cirrhosis, manifest hepatic encephalopathy is witnessed in 30-50% of patients and a subclinical course of disease in 50-70%. In other words, the frequency, the degree of severity and the course taken by HE depend on the underlying conditions. 

With regard to an altered state of consciousness, the subclinical form of PSE ranges between stages 0 (= normal) and I (= manifestation). (s. pp 270, 276) It is to be expected, as is the case with the majority of diseases, that the manifestation of hepatic encephalopathy will be preceded by a stage of latency. 

Fig. 15.3 Self-monitoring by the patient using a documentation programme for the early detection of subclinical hepatic encephalopathy or onset of oedema (s. fig. 10.1) (s. p. 305)...

Gitlin, N., Lewis, D.C., Hinkley, L. The diagnosis and prevalence of subclinical hepatic encephalopathy in apparently healthy, ambulant, non-shunted patients with cirrhosis. J. Hepatol. 1986 3 75-82... 

Marchesini, G., Zoli, M., Dondi, C., Cecchini, L., Angiolini, A., Bian-chi, F.B., Pisi, E. Prevalence of subclinical hepatic encephalopathy in cirrhotics and relationship to plasma amino acid imbalance. Dig. Dis. Sci. 1980 25 763-768... 

Miquel, J., Barcena, R., Boixeda, D., Fernandez, J., Lopez-San Roman, A., Martin-de-Argila, C., Ramosa, F. Role of Helicobacter pylori infection and its eradication in patients with subclinical hepatic encephalopathy. Eur. J. Gastroenterol. Hepatol. 2001 13 1067-1072... 

Quero, XC., Schalm, S.W. Subclinical hepatic encephalopathy. Semin. Liver Dis. 1996 16 321-328... 

Romero-Gomez, M, Boza, F., Garcia-Valdecasas, M S., Garcia, E., Ag-uilar-Reina, J. Subclinical hepatic encephalopathy predicts the development of overt hepatic encephalopathy. Amer. J. Gastroenterol. 2001 96 2718 - 2723... 

Silva, G., Segovia, R., Ponce, R., Backhouse, C., Palma, M., Roblero, J.R, Abadal, J., Quijada, C, Troncoso, M., Iturri a, H. Effects of 5-isosorbide mononitrate and propranol on subclinical hepatic encephalopathy and renal functions in patients with liver cirrhosis. Hepato-Gastroenterol. 2002 49 1357-1362... 

Watanabe, A., Sakai, T., Sato, S., Imai, F., Ohio, M., Arakawa, Y., Tod G., KobayasU, K., Muto, Y., Tsujii, T., Kawasaki, H., Okita, K., Tanikawa, K., Fujiyama, S., Shimada, S. Clinical efficacy of lactulose in cirrhotic patients with and without subclinical hepatic encephalopathy. Hepatology 1997 26 1410-1414... 

Yang, S.S., Lai, Y.C., CMang, T.R., Chen, D.F., Chen, D.S. Role of zinc in subclinical hepatic encephalopathy comparison with somato-sencory-evoked potentials. J. Gastroenterol. Hepatol. 2004 19 375-379... 

Isosorbide-5-mononitrate has been tested with and without propranolol in a placebo-controlled study in 30 patients with liver cirrhosis and esophageal varices (22). The aim of the study was to assess the severity of previously reported adverse effects (that is renal dysfunction and hepatic encephalopathy) when vasoactive drugs are used to prevent variceal bleeding. Neither isosorbide-5-mononitrate nor propranolol alone or together had any adverse effect on subclinical hepatic encephalopathy or renal function in patients with well-compensated cirrhosis. Severe headache in those taking isosorbide caused three patients to withdraw. 

In the case of chronic liver disease, episodic HE and persistent HE were defined and the term minimal hepatic encephalopathy (MHE) was coined to replace the hitherto inappropriate term subclinical encephalopathy . It is expected that this new system of classification will help to dispel the confusion frequently present in current textbook definitions and to facilitate multi-centre clinical trials in HE. 

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