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World J Gastroenterol. Dec 28, 2018; 24(48): 5446-5453
Published online Dec 28, 2018. doi: 10.3748/wjg.v24.i48.5446
Quality of life in patients with minimal hepatic encephalopathy
Lorenzo Ridola, Silvia Nardelli, Stefania Gioia, Oliviero Riggio
Lorenzo Ridola, Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina 04100, Italy
Silvia Nardelli, Stefania Gioia, Oliviero Riggio, Department of Clinical Medicine, Sapienza University of Rome, Rome 00185, Italy
Author contributions: Ridola L contributed to conception and design, analysis and interpretation of the data, drafting of the article, critical revision of the article for important intellectual content and final approval of the article; Nardelli S and Gioia S contributed to acquisition of data and critical revision of the article; Riggio O contributed to critical revision of the article for important intellectual content and final approval of the article.
Conflict-of-interest statement: The authors have declared no conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Lorenzo Ridola, MD, PhD, Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Corso della Repubblica, Latina 04110 Italy. lorenzo.ridola@uniroma1.it
Telephone: +39-773-6556155 Fax: +39-773-6556155
Received: October 5, 2018
Peer-review started: October 5, 2018
First decision: November 1, 2018
Revised: November 8, 2018
Accepted: November 9, 2018
Article in press: November 9, 2018
Published online: December 28, 2018
Abstract

Minimal hepatic encephalopathy (MHE) represents the mildest type of hepatic encephalopathy (HE). This condition alters the performance of psychometric tests by impairing attention, working memory, psychomotor speed, and visuospatial ability, as well as electrophysiological and other functional brain measures. MHE is a frequent complication of liver disease, affecting up to 80% of tested patients, depending of the diagnostic tools used for the diagnosis. MHE is related to falls, to an impairment in fitness to drive and the development of overt HE, MHE severely affects the lives of patients and caregivers by altering their quality of life (QoL) and their socioeconomic status. MHE is detected in clinically asymptomatic patients through appropriate psychometric tests and neurophysiological methods which highlight neuropsychological alterations such as video-spatial orientation deficits, attention disorders, memory, reaction times, electroencephalogram slowing, prolongation of latency evoked cognitive potentials and reduction in the critical flicker frequency. Several treatments have been proposed for MHE treatment such as non-absorbable disaccharides, poorly absorbable antibiotics such rifaximin, probiotics and branched chain amino acids. However, because of the multiple diagnosis methods, the various endpoints of treatment trials and the variety of agents used in trials, to date the treatment of MHE is not routinely recommended apart from on a case-by-case basis. Aim of this review is analyze the burden of MHE on QoL of patients and provide a brief summary of therapeutic approaches.

Keywords: Cirrhosis, Minimal hepatic encephalopathy, Covert hepatic encephalopathy, Health related quality of life

Core tip: Minimal hepatic encephalopathy (MHE) being related to falls, an impairment in fitness to drive and the development of overt hepatic encephalopathy (HE), severely affects the lives of patients and caregivers by altering their quality of life (QoL) and their socioeconomic status. The aim of this review is to analyze the burden of MHE on QoL of patients and provide a brief summary of therapeutic approaches.