PATIENTS WITH CIRRHOSIS OR PORTO-SYSTEMIC

SHUNTS THAT SHOULD UNDERGO

TESTS FOR MINIMAL HE
• patients at risk of accidents

• active drivers

• risks at work

• patients that complain of cognitive symptoms

• psychomotor performance: “I have difficulty doing handwork...”

• decreased attention: “I am confused...”

• poor memory: “I forget a lot...”

• patients with decline in work performance observed by relatives or colleagues

Simon-Talero M. et al, in Therapy of Liver Diseases, 2013.

 RECOMMENDATIONS FOR PATIENTS
WITH MINIMAL HE

• assessment of the implications on daily life activities (use a quality

of life index)

• ask patients and informants (relatives, friends) questions about

possible cognitive decline

• clarify wether cognitive complaints could be due to minimal HE

• life habits

• avoid situations that may lead to accidents

• consider driving restrictions

Simon-Talero M. et al, in Therapy of Liver Diseases, 2013.

 RECOMMENDATIONS FOR PATIENTS
WITH MINIMAL HE

• medical therapy

• evaluate the possible benefits of therapy

• discuss with the patient the value of a “trial of therapy”

• select therapeutic targets:

– cognitive index + quality of life index

• select therapeutic agents:

– non-absorbable disaccharides, rifaximin

• perform pairs of trials for 1- to -3months periods

• assess effectiveness and side effects

• decide on continuation f therapy

Simon-Talero M. et al, in Therapy of Liver Diseases, 2013.

Rifaximin was associated with
improved long-term survival

Vlachogiannakos J, et al. J Gastroenterol Hepatol 2013;28:450-5

 Classification of HE for research
and clinical use
Clinical features Clinical definition Research definition
No specific symptom and Unimpaired Unimpaired
normal specialized testing
results
No specific symptoms Covert Minimal
but abnormal specialized
testing results
Nonspecific changes Grade I
without asterixis with
abnormal specialized
testing results
Disorientation, asterixis, Overt Grade II
change in consciousness Grade III
through coma. Coma
Specialized testing not required
for diagnosis

Bajaj JS,et al. Hepatology 2009;50:2014–2021

 CLASSIFICATION OF THE HE

Current system of classification of HE

Combining MHE and grade I HE into covert HE

Kappus M, Clinical Gastroenterology and Hepatology 2012, 10:1208-1219

“The Stroop smartphone application is a short and valid
method to screen for minimal hepatic encephalopathy”
Bajaj JS, Thacker LR, Heuman DM, et al.
Hepatology 2013 Sep;58(3):1122-32

“Smart applications for assessing minimal hepatic

encephalopathy: Novelty from the app revolution ”
Amodio P, Cordoba J.
Hepatology 2013 Sep;58(3):844-6.