Canadian Journal of Gastroenterology最新文献

{"title":"Hypersecretory villous adenoma as the primary cause of an intestinal intussusception and McKittrick-Wheelock syndrome.","authors":"Susana Sanchez Garcia, Pedro Villarejo Campos, Maria Del Carmen Manzanares Campillo, Aurora Gil Rendo, Virginia Muñoz Atienza, Esther Pilar García Santos, Francisco Javier Ruescas García, Jose Luis Bertelli Puche","doi":"10.1155/2013/252156","DOIUrl":"https://doi.org/10.1155/2013/252156","url":null,"abstract":"Intestinal invagination or intussusception is the most common cause of intestinal obstruction in children and represent 5% of adult cases. This intestinal obstruction is due to a lesion in the intestinal mucosa that initiates intussusception or intestinal invagination (90% of adult cases are malignant). Moreover, villous adenomas, which represent malignant potential, are found within these lesions of intestinal mucosa. There are variants of villous adenomas known as hypersecretory adenomas, which are described as intestinal lesions located more frequently in the rectum and distal colon. In addition, these variant adenomas can cause hypersecretory diarrhea and an electrolyte disturbance known as McKittrick-Wheelock syndrome.","PeriodicalId":55285,"journal":{"name":"Canadian Journal of Gastroenterology","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2013-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2013/252156","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31840554","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Percutaneous liver biopsy practice patterns among Canadian hepatologists.","authors":"Mohammed Aljawad,&nbsp;Eric M Yoshida,&nbsp;Julia Uhanova,&nbsp;Paul Marotta,&nbsp;Natasha Chandok","doi":"10.1155/2013/429834","DOIUrl":"https://doi.org/10.1155/2013/429834","url":null,"abstract":"<p><strong>Background: </strong>Percutaneous liver biopsy (PLB) is the standard procedure to obtain histological samples essential for the management of various liver diseases. While safe, many hepatologists no longer perform their own PLBs; the reasons for this practice shift are unknown.</p><p><strong>Objective: </strong>To describe the attitudes, practice patterns and barriers to PLB among hepatologists in Canada.</p><p><strong>Methods: </strong>A survey was distributed to all hepatologists in Canada.</p><p><strong>Results: </strong>Thirty-two of 40 (80%) hepatologists completed the survey; the majority of respondents were male (72%) and had been in practice for >5 years in an academic setting. Fifty-six per cent of hepatologists referred all PLBs to radiology, and only 19% of hepatologists reported performing their own PLBs most or all of the time. There were no sex differences nor were there differences based on years in practice. Fifty per cent of respondents who performed PLB routinely used ultrasound, and PLBs are performed in equal frequency in an ambulatory procedure area (50%) versus the endoscopy suite (36%). For almost one-half of hepatologists (47%), their performance of PLBs decreased in the past five years. The majority of respondents at an academic centre (75%) reported access to FibroScan (Echosens, France), and most estimated a resultant 25% to 50% reduction in the need for PLBs. Lack of resources, patient preference and suboptimal reimbursement were the most common reasons cited for not performing PLBs.</p><p><strong>Conclusion: </strong>Most hepatologists in Canada do not perform PLBs to the extent that they did in the past, but refer to radiology. The reasons for this shift in practice include lack of resources, improved perception of safety and patient preference. Where available, FibroScan resulted in a perceived 25% to 50% reduction in required liver biopsies.</p>","PeriodicalId":55285,"journal":{"name":"Canadian Journal of Gastroenterology","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2013-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2013/429834","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31839897","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gastric biopsies: the gap between evidence-based medicine and daily practice in the management of gastric Helicobacter pylori infection.","authors":"Hala El-Zimaity,&nbsp;Stefano Serra,&nbsp;Eva Szentgyorgyi,&nbsp;Rajkumar Vajpeyi,&nbsp;Amir Samani","doi":"10.1155/2013/897423","DOIUrl":"https://doi.org/10.1155/2013/897423","url":null,"abstract":"<p><strong>Background: </strong>Many consider histology to be the gold standard for Helicobacter pylori detection. Because the number and distribution of H pylori organisms vary, particularly in patients taking proton pump inhibitors (PPIs), the American Gastroenterological Association recommends discontinuing PPIs two weeks before endoscopy, and taking biopsies from both the body and antrum.</p><p><strong>Objective: </strong>To assess the influence of clinical practice on the histopathological detection of H pylori infection.</p><p><strong>Methods: </strong>Electronic patient records were evaluated for the sites of gastric sampling and PPI use at endoscopy. One hundred fifty cases with biopsies taken from both antrum and body were randomly selected for pathological re-review with special stains. The gastric regions sampled, H pylori distribution and influence of clinical factors on pathological interpretation were assessed.</p><p><strong>Results: </strong>Between 2005 and 2010, 10,268 biopsies were taken to detect H pylori. Only one region was sampled in 60% of patients (antrum 47%, body 13%). Re-review of biopsies taken from both antrum and body indicated that the correct regions were sampled in only 85 (57%) patients. Of these, 54 were H pylori positive and 96 were H pylori negative. H pylori was present in the antrum in only 15% of the patients and body only in 21%. Of 96 H pylori-negative patients, two were reinterpreted as positive. Forty-seven per cent of patients were taking PPIs at endoscopy, contributing to both false-negative and false-positive diagnoses.</p><p><strong>Conclusion: </strong>Despite national and international guidelines for managing H pylori infection, the American Gastroenterological Association guidelines are infrequently adhered to, with PPIs frequently contributing to false diagnosis; sampling one region only increases the likelihood of missing active infection by at least 15%.</p>","PeriodicalId":55285,"journal":{"name":"Canadian Journal of Gastroenterology","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2013-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2013/897423","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31791622","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Esophagitis dissecans superficialis: a case report and literature review.","authors":"Shumona De,&nbsp;Geoffrey S Williams","doi":"10.1155/2013/923073","DOIUrl":"https://doi.org/10.1155/2013/923073","url":null,"abstract":"Esophagitis dissecans superficialis (EDS) is a rare condition characterized classically by sloughing of the esophageal mucosa, followed by vomiting or regurgitation of the esophageal cast (1). Since the advent of endoscopy, less dramatic cases of EDS have been diagnosed, characterized by stripped, whitish mucosa with or without bleeding, vertical fissures and circumferential cracks, in addition to long, linear mucosal breaks. EDS can be associated with medications such as bisphosphonates or nonsteroidal anti-inflammatory drugs, chemical irritants, celiac disease, hot beverages, autoimmune bullous dermatoses or idiopathy (2). EDS is known to be a benign condition that usually resolves without lasting pathological changes. Although biopsies from the esophageal mucosa of patients with EDS are sometimes associated with fungal or bacterial colonies (3), we report a case in which the appearance of EDS mimicked candidal esophagitis, and highlight the need to consider EDS in a differential diagnosis.","PeriodicalId":55285,"journal":{"name":"Canadian Journal of Gastroenterology","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2013-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2013/923073","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31792721","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Subsequent entry biologics - opportunities and challenges.","authors":"Subrata Ghosh","doi":"10.1155/2013/634176","DOIUrl":"https://doi.org/10.1155/2013/634176","url":null,"abstract":"Currently, infliximab and adalimumab are the two antitumour necrosis factor (TNF) agents available in Canada for the treatment of Crohn disease and ulcerative colitis (adalimumab is not yet licensed for use in ulcerative colitis). At least one more anti-TNF monoclonal antibody (golimumab) is awaiting approval. Furthermore, the gut-specific antiadhesion antibody vedolizumab is also on the horizon for inflammatory bowel disease (IBD). \u0000 \u0000 \u0000Subsequent entry biologics (SEBs), also known as biosimilars, are monoclonal antibodies that are similar but not identical to the reference biologic drug (RBD). With the patents for anti-TNF antibodies, such as infliximab, coming to an end, anti-TNF SEBs have been manufactured and an important overview of this has been provided by Devlin et al (1) (pages 567–571) in the current issue of the Journal. Given the cost of biological drugs, the potential for SEBs to lower cost, both by virtue of lower cost of SEBs and competitive lowering of cost of RBDs, will be welcome. SEBs are already on the market in some geographical jurisdictions, such as South Korea, and are well on the way to approval in Europe. There are, however, certain considerations that may be of clinical relevance to practising gastroenterologists in Canada, which include the following: \u0000 \u0000 \u0000Are the molecular structures of SEBs and RBDs comparable?: Subtle differences in structure, such as fucosylated forms, may affect antibody-dependent cell-mediated cytotoxicity and binding to FcγR, which may affect drug clearance and serum drug levels. Therefore, SEBs cannot be viewed as a generic RBD (2). It is also not clear whether the ‘molecular drift’ between SEBs and RBDs may widen over time as part of the manufacturing process. \u0000 \u0000 \u0000Are the pharmacokinetics of SEBs and RBDs comparable?: RBDs are used in combination with methotrexate in rheumatoid arthritis, as monotherapy in ankylosing spondylitis, and often in psoriasis and in combination with azathioprine in IBD. The doses are different for different indications in the case of RBDs. Therefore, comprehensive pharmacokinetic studies at low and high dose levels, as well as single and multiple doses, may be required to ensure the comparability of SEBs and RBDs. Serum drug levels are critical for the efficacy of monoclonal antibodies in immune-mediated inflammatory diseases (3). \u0000 \u0000 \u0000Are trial designs sufficiently robust to test efficacy comparability of SEBs and RBDs?: Equivalency studies with sufficiently narrow comparability margins to establish efficacy may require very large studies, which are difficult to conduct, and would compete for the same patients who may otherwise enter studies for the development of novel compounds for the treatment of IBD. For logistical reasons, such very large equivalence studies may not be performed. \u0000 \u0000 \u0000Are the immunogenicities of SEBs and RBDs comparable?: Immunogenicity of biological drugs is an important consideration and depends on the molecular structure of the monoclonal","PeriodicalId":55285,"journal":{"name":"Canadian Journal of Gastroenterology","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2013-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2013/634176","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31792722","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Capnography improves detection of apnea during procedural sedation for percutaneous transhepatic cholangiodrainage.","authors":"Christoph Schlag,&nbsp;Alexandra Wörner,&nbsp;Stefan Wagenpfeil,&nbsp;Eberhard F Kochs,&nbsp;Roland M Schmid,&nbsp;Stefan von Delius","doi":"10.1155/2013/852454","DOIUrl":"https://doi.org/10.1155/2013/852454","url":null,"abstract":"<p><strong>Background: </strong>Capnography provides noninvasive monitoring of ventilation and can enable early recognition of altered respiration patterns and apnea.</p><p><strong>Objective: </strong>To compare the detection of apnea and the prediction of oxygen desaturation and hypoxemia using capnography versus clinical surveillance during procedural sedation for percutaneous transhepatic cholangiodrainage (PTCD).</p><p><strong>Methods: </strong>Twenty consecutive patients scheduled for PTCD were included in the study. All patients were sedated during the procedure using midazolam and propofol. Aside from standard monitoring, additional capnographic monitoring was used and analyzed by an independent observer.</p><p><strong>Results: </strong>The mean (± SD) cumulative duration of apnea demonstrated by capnography was significantly longer than the mean cumulative duration of clinically detected apnea (207.5 ± 348.8 s versus 8.2 ± 17.9 s; P=0.015). The overall number of detected episodes of apnea was also significantly different (113 versus seven; P=0.012). There were 15 events of oxygen desaturation (decrease in oxygen saturation [SaO2] ≥ 5%), which were predicted in eight of 15 cases by capnography and in one of 15 cases by clinical observation. There were three events of hypoxemia (SaO2 <90%) that were predicted in three of three cases by capnography and in one of three cases by clinical observation.</p><p><strong>Conclusion: </strong>Capnographic monitoring was superior to clinical surveillance in the detection of apnea and in the prediction of oxygen desaturation during procedural sedation for PTCD.</p>","PeriodicalId":55285,"journal":{"name":"Canadian Journal of Gastroenterology","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2013-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2013/852454","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31792726","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Canadian Association of Gastroenterology position statement: hip fracture and proton pump inhibitor therapy-a 2013 update.","authors":"Paul Moayyedi,&nbsp;Yuhong Yuan,&nbsp;Grigorios Leontiadis","doi":"10.1155/2013/321379","DOIUrl":"https://doi.org/10.1155/2013/321379","url":null,"abstract":"Health Canada recently provided an information update on proton pump inhibitor (PPI) therapy and risk of fracture in April 2013 (1) stating “Several scientific studies suggest that PPI therapy may be associated with a small increased risk for fractures of the hip, wrist, or spine related to osteoporosis, a disease resulting in the weakening of bones. The risk of fracture was higher in patients who received multiple daily doses of PPIs and therapy for a year or longer. Additional risk factors for osteoporosis, such as age, gender and the presence of other health conditions, may also contribute to the increased risk of fractures. At Health Canada’s request, manufacturers of all PPIs marketed in Canada have updated the drug labels for their products to include information on this risk.”","PeriodicalId":55285,"journal":{"name":"Canadian Journal of Gastroenterology","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2013-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2013/321379","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31881482","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A pilot study examining the relationship among Crohn disease activity, glucagon-like peptide-2 signalling and intestinal function in pediatric patients.","authors":"David L Sigalet, Dragan Kravarusic, Decker Butzner, Bolette Hartmann, Jens J Holst, Jon Meddings","doi":"10.1155/2013/460958","DOIUrl":"10.1155/2013/460958","url":null,"abstract":"<p><strong>Unlabelled: </strong>BACKGROUND⁄</p><p><strong>Objectives: </strong>The relationship between the enteroendocrine hormone glucagon-like peptide 2 (GLP-2) and intestinal inflammation is unclear. GLP-2 promotes mucosal growth, decreases permeability and reduces inflammation in the intestine; physiological stimulation of GLP-2 release is triggered by nutrient contact. The authors hypothesized that ileal Crohn disease (CD) affects GLP-2 release.</p><p><strong>Methods: </strong>With ethics board approval, pediatric patients hospitalized with CD were studied; controls were recruited from local schools. Inclusion criteria were endoscopy-confirmed CD (primarily of the small intestine) with a disease activity index >150. Fasting and postprandial GLP-2 levels and quantitative urinary recovery of orally administered 3-O-methyl-glucose (active transport) and lactulose⁄mannitol (passive) were quantified during the acute and remission phases.</p><p><strong>Results: </strong>Seven patients (mean [± SD] age 15.3 ± 1.3 years) and 10 controls (10.3 ± 1.6 years) were studied. In patients with active disease, fasting levels of GLP-2 remained stable but postprandial levels were reduced. Patients with active disease exhibited reduced glucose absorption and increased lactulose⁄mannitol recovery; all normalized with disease remission. The change in the lactulose⁄mannitol ratio was due to both reduced lactulose and increased mannitol absorption.</p><p><strong>Conclusions: </strong>These findings suggest that pediatric patients with acute ileal CD have decreased postprandial GLP-2 release, reduced glucose absorption and increased intestinal permeability. Healing of CD resulted in normalization of postprandial GLP-2 release and mucosal functioning (nutrient absorption and permeability), the latter due to an increase in mucosal surface area. These findings have implications for the use of GLP-2 and feeding strategies as a therapy in CD patients; further studies of the effects of inflammation and the GLP-2 axis are recommended.</p>","PeriodicalId":55285,"journal":{"name":"Canadian Journal of Gastroenterology","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2013-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3805340/pdf/cjg27587.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31792727","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Overview of subsequent entry biologics for the management of inflammatory bowel disease and Canadian Association of Gastroenterology position statement on subsequent entry biologics.","authors":"Shane M Devlin, Brian Bressler, Charles N Bernstein, Richard N Fedorak, Alain Bitton, Harminder Singh, Brian G Feagan","doi":"10.1155/2013/327120","DOIUrl":"10.1155/2013/327120","url":null,"abstract":"The advent of biologic molecules is one of the most important therapeutic advances to have occurred in the medical management of inflammatory bowel disease (IBD). From a Canadian perspective, the monoclonal antibodies directed against tumour necrosis factor-alpha (TNF-α), namely infliximab (Remicade, Johnson & Johnson, USA) and adalimumab (Humira, AbbVie Corporation, USA), are the only approved and commercially available biologics for the treatment of either Crohn disease (CD) or ulcerative colitis (UC) in Canada. \u0000 \u0000These molecules have a large and complex structure and are generated with the aid of DNA recombination technology. This complexity makes the development of biologically similar substitutes – as is common with smaller, less complex molecules – a challenge. However, following the expiry of the patent on Remicade, a biosimilar infliximab has been developed (CT-P13, Remsima [Celltrion, South Korea], Inflectra [Hospira Inc, USA]). In addition, another biosimilar infliximab has been developed by an Indian pharmaceutical company, Reliance Life Sciences. \u0000 \u0000Standard, small-molecule pharmaceuticals are significantly different from their complex biological counterparts (Figure 1). Most synthesized pharmaceuticals have a molecular size of only a few hundred Daltons (Da) (eg, omeprazole is 345 Da). In comparison, infliximab is 149,000 Da. Moreover, monoclonal antibodies have a complex structure that is influenced by the vector and post-translational modification, among other factors (1–3). In addition, although the overall structure of a monoclonal antibody may be known, the manufacturing platform used by the manufacturer of the reference biologic drug (RBD) is not, due to the proprietary nature of the information. As such, a different biological system that is used to produce a biosimilar agent will likely translate into subtle differences that could be difficult to characterize. Such differences have the potential to translate into clinically relevant differences in efficacy, safety and immunogenicity. Therefore, it will be extremely challenging to ensure that a subsequent entry biologic (SEB) is, in fact, ‘equivalent’ to the RBD. Clinical equivalence can only be proven in clinical trials. \u0000 \u0000 \u0000 \u0000Figure 1) \u0000 \u0000Comparison between a biologic monoclonal antibody and an acetylsalicylic acid molecule. From Kozlowski S, Woodcock J, Midthun K, Behrman Sherman R. Developing the Nation’s Biosimilars Program. N Engl J Med 2011;365:385–8. Reprinted with ... \u0000 \u0000 \u0000 \u0000It is important for the Canadian gastroenterology community to gain a full understanding of the important issues in the context of the development and entry into the marketplace of such biologic agents. \u0000 \u0000 \u0000The objectives of the present document are to: \u0000 \u0000 \u0000Provide a brief primer on the terminology germane to this issue. \u0000 \u0000 \u0000Describe the current state of SEBs and the existing guidelines from Health Canada and other jurisdictions. \u0000 \u0000 \u0000Provide perspective on the potential opportunity in the Ca","PeriodicalId":55285,"journal":{"name":"Canadian Journal of Gastroenterology","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2013-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2013/327120","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31792723","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Minimal hepatic encephalopathy.","authors":"Laura M Stinton,&nbsp;Saumya Jayakumar","doi":"10.1155/2013/547670","DOIUrl":"https://doi.org/10.1155/2013/547670","url":null,"abstract":"<p><p>Minimal hepatic encephalopathy (MHE) is the earliest form of hepatic encephalopathy and can affect up to 80% of cirrhotic patients. By definition, it has no obvious clinical manifestation and is characterized by neurocognitive impairment in attention, vigilance and integrative function. Although often not considered to be clinically relevant and, therefore, not diagnosed or treated, MHE has been shown to affect daily functioning, quality of life, driving and overall mortality. The diagnosis of MHE has traditionally been achieved through neuropsychological examination, psychometric tests or the newer critical flicker frequency test. A new smartphone application (EncephalApp Stroop Test) may serve to function as a screening tool for patients requiring further testing. In addition to physician reporting and driving restrictions, medical treatment for MHE includes non-absorbable disaccharides (eg, lactulose), probiotics or rifaximin. Liver transplantation may not result in reversal of the cognitive deficits associated with MHE. </p>","PeriodicalId":55285,"journal":{"name":"Canadian Journal of Gastroenterology","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2013-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2013/547670","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31792724","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}