Gastroenterol. latinoam 2013; Vol 24, Nº4: 191-197
Minimal hepatic encephalopathy: current concepts of an emerging clinical entity
Autor(es):
✉ Paula Rey G. y Marco Arrese J.
Hepatic encephalopathy (HE) is a reversible neuropsychiatric disorder, consequence of hepatocellular failure and/or portal shunt to the systemic circulation. The neurological abnormalities are heterogeneous, affecting different cognitive and motor functions and its magnitude has a wide spectrum, ranging from a subclinical level (minimal hepatic encephalopathy, MHE) to coma. The relevance of MHE has been recognized only recently, with studies that have shown high prevalence among cirrhotic patients and significant complications such as poor quality of life, risk of vehicular accidents, predisposition to development overt HE and increased mortality. Despite this, one of the limitations for routine screening is the lack of a simple and objective diagnostic method, since MHE is not detectable by conventional medical assessment and diagnosis is only made through specialized tests that assess different cognitive domains. There isn´t a diagnostic gold standard; and some of the most recognizable methods that have been implemented in clinical practice in some countries are: Psychometric Hepatic Encephalopathy Score, Critical Flicker Frequency, and Inhibitory Control Test. The main therapies that have been evaluated for EHM are lactulose and rifaximin, with favorable impact on different outcomes. More multicentric studies with longer follow-up and clinically relevant outcomes that demonstrate the cost-effectiveness of screening and treatment of this important complication are needed.
