Hepatic encephalopathy: 7 reports on analysis, fecal microbiota transplant

Hepatic encephalopathy is one possible outcome of chronic liver diseases such as cirrhosis and hepatitis and results in forgetfulness, disorientation, and even movement problems. Grading hepatic encephalopathy is key to guiding care among these patients.

Healio presents the following reports on the latest techniques and models for predicting and grading HE, fecal microbiota transplant to improve brain function, and coil-assisted retrograde transvenous obliteration for HE caused by spontaneous portosystemic shunts.

Grading early hepatic encephalopathy requires additional training

Gastroenterology faculty, nurse practitioners and physician assistants had excellent concordance in classifying grade 2 or higher hepatic encephalopathy compared with gastroenterology and hepatology physicians, according to a recently published study. Lower grades, however, showed significant discordance between the two groups.

“Cirrhosis and hepatic encephalopathy (HE) is a major cause of morbidity and mortality in the United States, and the trend points towards a growing burden over time,” Bradley Reuter, MD, from the Virginia Commonwealth University, and colleagues wrote. “The current study results show that an accurate and reproducible assessment of lower grades of HE remains problematic even among trainees and practitioners of the subspecialty of gastroenterology.” Read more

Fecal microbiota transplant improves brain function in hepatic encephalopathy

Patients who underwent fecal microbiota transplant for recurrent hepatic encephalopathy had a lower risk for hospitalization and showed improve gut microbiome and brain function, according to this exclusive interview from the International Liver Congress 2018.

“These were patients ... who actually had multiple episodes of encephalopathy,” Jasmohan S. Bajaj, MD, from the Virginia Commonwealth University, told Healio Gastroenterology and Liver Disease. “We sought to treat the dysbiosis — which means the unbalanced gut microbiota — by a stool transplant from one donor. This one donor was selected to have the highest amount of the good bacteria.” Read more

Animal naming test measures hepatic encephalopathy progression

Researchers found that a simplified version of the animal naming verbal response test was an easy, patient-accessible measure for the assessment of hepatic encephalopathy, according to a recently published study.

“Liver cirrhosis may disrupt brain function; however, in daily practice no physician measures it. The maximum number of animals that a patient is able to list in a minute is a simple, no cost, easily obtainable measure of mental function that should be added to everyday hepatologic practice to detect changes in mental function. In addition, it provides information about the risk for hepatic encephalopathy (HE),” Piero Amodio, MD, of the University of Padova, Italy, told Healio Gastroenterology and Liver Disease. Read more

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Composite score predicts hepatic encephalopathy admission

The MoCA-CFS composite score — developed using the Montreal Cognitive Assessment and the Clinical Frailty Scale — independently predicted hospital admissions for hepatic encephalopathy and impaired health-related quality of life among patients with cirrhosis, according to recently published data.

“There is a clinical need to identify more practical screens that can assist us to determine which patients are at high risk of short-term [hepatic encephalopathy (HE)]-related hospital admissions,” Michael Ney, MD, from the University of Alberta in Canada, and colleagues wrote. “Once identified, management of these high-risk patients can be intensified in an attempt to reduce admission rates and the associated healthcare costs.” Read more

CARTO technique safe, effective for overt hepatic encephalopathy

Coil-assisted retrograde transvenous obliteration was safe and effective in treating patients with refractory overt hepatic encephalopathy caused by spontaneous portosystemic shunts, according to recently published data.

The CARTO procedure is a modified form of balloon-occluded retrograde transvenous obliteration (BRTO) that involves the use of coils and Gelfoam (Pfizer) instead of indwelling balloons and sclerosing agents. Read more

Model accurately predicts cirrhosis-driven hepatic encephalopathy

A recently published study reports on the development of two risk-score models to predict the 1-year and 5-year probability for hepatic encephalopathy in patients with cirrhosis, based on statin use and total bilirubin and albumin.

“We found that the risk of [hepatic encephalopathy] in patients with cirrhosis can be stratified by two readily available lab tests and a brief inventory of the medication list,” Elliot B. Tapper, MD, from the department of gastroenterology and hepatology, University of Michigan, and colleagues wrote. “The potential benefits of statins in preventing [hepatic encephalopathy] need to be studied in rigorously designed randomized controlled trials. This is particularly important for patients with cirrhosis for whom there is no effective treatment to eliminate or control the underlying cause.” Read more

FMT improved cognitive function in hepatic encephalopathy

A cohort of 10 men with hepatic encephalopathy experienced improvement in several outcomes, including cognitive function, after fecal microbiota transplantation from the same donor, according to data presented at the International Liver Congress.

“FMT from a rationally selected donor was safe, associated with lower hospitalizations, especially related to recurrent HE and improved cognitive tests among cirrhotic patients with recurrent HE,” Jasmohan S. Bajaj, MD, associate professor in the department of internal medicine and the division of gastroenterology at Virginia Commonwealth University in Richmond, said. “Hepatic encephalopathy is the most elegant model of the gut, liver, and brain axis.” Read more