Minimal Hepatic Encephalopathy Is An Under Recognized Entity in Clinical Practice Of Bangladeshi Physicians

Abstract

Background and Aim: Minimal hepatic encephalopathy is characterized by subtle motor and cognitive deficits and impairs health related quality of life. Though the prevalence of minimal hepatic encephalopathy in cirrhotic patients is high, but awareness regarding minimal hepatic encephalopathy is not yet satisfactory. More over for diagnosis of minimal hepatic encephalopathy, the cutoff normative value for psychometric test is not yet established in Bangladesh. This is the first study in Bangladesh to find out the normative value for psychometric test and see the prevalence minimal hepatic encephalopathy in cirrhotic patients. Method: Cross sectional study done in Department of Hepatology, Bangabandhu Sheikh Mujib Medical University. Total 150 patients, of whom 50 were patients with cirrhosis and remaining 100 healthy individuals, were included in the study. By doing number connection test, serial dotting test and line tracing test in healthy individual, normative values for psychometric test were first detected then these tests were done on cirrhotic patients, whose 2 psychometric test result among 3 above normal value were enrolled as of Bangabandhu Sheikh Mujib Medical University. None of the patients were previously diagnosed as having any type of hepatic encephalopathy. Results: Cutoff normative value for NCT, SDT, LTT was 52 seconds, 52 seconds and 84 seconds respectively (Mean + 2SD). Prevalence of minimal hepatic encephalopathy in this study was 66% and it was more prevalent in advanced cirrhosis. Conclusion: Minimal hepatic encephalopathy is frequent among patients with liver cirrhosis, manifested even in patients with child A liver cirrhosis. Every attention should be given to detect minimal hepatic encephalopathy in patients with cirrhosis of liver well before the development of overt hepatic encephalopathy. The authors have none to declare.