Hepatic encephalopathy in non-cirrhotic portal hypertension.

IF 3.2 3区 医学 Q2 ENDOCRINOLOGY & METABOLISM
Babu Lal Meena, Ananthu Narayan S J, Shiv Kumar Sarin
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引用次数: 0

Abstract

Hepatic encephalopathy (HE) is traditionally associated with hepatic parenchymal diseases, such as acute liver failure and cirrhosis. Its prevalence in non-cirrhotic portal hypertension (NCPH) patients, extrahepatic portal vein obstruction (EHPVO), and non-cirrhotic portal fibrosis (NCPF) is less well described. HE in NCPH allows one to study the effect of portosystemic shunting and ammonia without significant hepatic parenchymal injury. The current review narrates the spectrum and management of hepatic encephalopathy in NCPH patients. We synthesized data from various studies on the occurrence and management of HE in NCPH, mainly EHPVO, idiopathic non-cirrhotic portal hypertension (INCPH), and porto-sinusoidal vascular disease (PSVD). The prevalence of minimal hepatic encephalopathy (MHE) in NCPH is reported from 12 to 60%, depending on the condition and diagnostic criteria. MHE was reported in nearly a third of EHPVO patients. Studies show that venous ammonia levels are significantly elevated in patients with MHE and spontaneous shunts (82.4 ± 20.3 vs. 47.1 ± 16.7 µmol/L, P = 0.001). Large portosystemic shunts substantially increase the risk of HE, with 46-71% of patients with persistent or recurrent HE having identifiable shunts. Management of HE in NCPH primarily focuses on reducing ammonia levels through lactulose, which has shown improvement in 53% of patients with MHE after three months (P = 0.001). Shunt occlusion in patients with large portosystemic shunts is helpful in selected cases. HE in NCPH, particularly in EHPVO, is associated with elevated ammonia levels and spontaneous shunts. Despite the high prevalence of HE in NCPH, this is still a neglected aspect in the care of NCPH. A high index of suspicion and the application of appropriate screening tools are crucial for timely diagnosis and management. HE screening tools that are well-studied in cirrhosis, are also valid in NCPH. Effective management strategies include lactulose, rifaximin, dietary modifications, and shunt embolisation in some cases. Future research should focus on the long-term natural history and efficacy of treatment strategies in this population.

非肝硬化门静脉高压症的肝性脑病。
肝性脑病(HE)传统上与肝实质疾病有关,如急性肝功能衰竭和肝硬化。其在非肝硬化门静脉高压(NCPH)患者、肝外门静脉梗阻(EHPVO)和非肝硬化门静脉纤维化(NCPF)中的患病率尚不清楚。在NCPH中HE允许人们在没有明显肝实质损伤的情况下研究门静脉系统分流和氨的影响。目前的综述叙述了NCPH患者肝性脑病的频谱和管理。我们综合了NCPH中HE发生和管理的各种研究数据,主要是EHPVO、特发性非肝硬化门脉高压(INCPH)和门窦血管病(PSVD)。根据病情和诊断标准,NCPH中轻度肝性脑病(MHE)的患病率从12%到60%不等。据报道,近三分之一的EHPVO患者存在MHE。研究表明,MHE和自发分流患者的静脉氨水平显著升高(82.4±20.3 vs. 47.1±16.7µmol/L, P = 0.001)。大门静脉系统分流大大增加了HE的风险,46-71%的持续性或复发性HE患者有可识别的分流。NCPH中HE的管理主要侧重于通过乳果糖降低氨水平,三个月后,53%的MHE患者的氨水平得到改善(P = 0.001)。分流闭塞的病人大门静脉分流是有帮助的,在选定的情况下。NCPH中的HE,特别是EHPVO,与氨水平升高和自发分流有关。尽管在NCPH中HE的患病率很高,但这仍然是NCPH护理中被忽视的一个方面。高怀疑指数和应用适当的筛查工具对于及时诊断和管理至关重要。肝硬化的HE筛查工具在NCPH中也是有效的。有效的管理策略包括乳果糖、利福昔明、饮食调整和分流栓塞。未来的研究应集中在这一人群的长期自然历史和治疗策略的有效性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Metabolic brain disease
Metabolic brain disease 医学-内分泌学与代谢
CiteScore
5.90
自引率
5.60%
发文量
248
审稿时长
6-12 weeks
期刊介绍: Metabolic Brain Disease serves as a forum for the publication of outstanding basic and clinical papers on all metabolic brain disease, including both human and animal studies. The journal publishes papers on the fundamental pathogenesis of these disorders and on related experimental and clinical techniques and methodologies. Metabolic Brain Disease is directed to physicians, neuroscientists, internists, psychiatrists, neurologists, pathologists, and others involved in the research and treatment of a broad range of metabolic brain disorders.
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