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. 2014 Sep-Oct;20(5):304-8.
doi: 10.4103/1319-3767.141692.

A survey of patterns of practice and perception of minimal hepatic encephalopathy: a nationwide survey in India

Praveen Sharma  1 , Barjesh C Sharma
Affiliations

A survey of patterns of practice and perception of minimal hepatic encephalopathy: a nationwide survey in India

Praveen Sharma et al. Saudi J Gastroenterol. 2014 Sep-Oct.

Abstract

Background/aim: Minimal hepatic encephalopathy (MHE) leads to overt hepatic encephalopathy (HE) and impairs quality of life in patients with cirrhosis. Awareness of MHE and its management among physicians is not known.

Patients and methods: We conducted a survey among 673 physicians in India from academic and nonacademic institutes to understand the clinical burden, perceived severity, management patterns, and the barriers to providing care for this condition.

Results: Overall awareness of MHE in this survey was 75% (n = 504). Awareness of MHE was significantly higher in physicians working in teaching hospitals compared with those in nonteaching hospitals (79% vs 71%, P = 0.02). Similarly, gastroenterologists were more aware of MHE compared with nongastroenterologists (91% vs 66%, P = 0.001). Only 6.3% physicians screened all of their patients for MHE, whereas frequency of testing for MHE, either being nil or less than 10% of their patients was 64.7%. The most common test was paper and pencil test (86%) and the reason for nonscreening was nonavailability of time to test and also equipment or method (81%). A majority of physicians (88%) think that MHE affects quality of life. Physicians (61%) had an opinion that there should be some registry of MHE regardless of the cost and effort involved. Lactulose was used in 93% of cases, followed by rifaximin (82%) in the management of MHE.

Conclusion: The overall awareness of MHE was 75% and it was significantly more in physicians of academic institutes. Despite awareness of its effect on quality of life, a majority of physicians did not test for MHE in their day-to-day practice.

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Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1
Figure 1
Frequency of testing minimal hepatic encephalopathy in patients with cirrhosis by gastroenterologists and nongastroenterologists
Figure 2
Figure 2
Treatment used by gastroenterologists and nongastroenterologists in the management of minimal hepatic encephalopathy. ‘Rifaximin use between gastroenterologists and nongastroenterologists is significant (P = 0.001)’
See this image and copyright information in PMC

References

    1. Ferenci P, Lockwood A, Mullen K, Tarter R, Weissenborn K, Blei AT. Hepatic encephalopathy-definition, nomenclature, diagnosis, and quantification: Final report of the working party at the 11th World Congresses of Gastroenterology, Vienna, 1998. Hepatology. 2002;35:716–21. - PubMed
    1. Das A, Dhiman RK, Saraswat VA, Verma M, Naik SR. Prevalence and natural history of subclinical hepatic encephalopathy in cirrhosis. J Gastroenterol Hepatol. 2001;16:531–5. - PubMed
    1. Groeneweg M, Moerland W, Quero JC, Hop WC, Krabbe PF, Schalm SW. Screening of subclinical hepatic encephalopathy. J Hepatol. 2000;32:748–53. - PubMed
    1. Sharma P, Sharma BC, Puri V, Sarin SK. An open-label randomized controlled trial of Lactulose and probiotics in the treatment of minimal hepatic encephalopathy. Eur J Gastroenterol Hepatol. 2008;20:506–11. - PubMed
    1. Prasad S, Dhiman RK, Duseja A, Chawla Y, Sharma A, Agarwal R. Lactulose improves cognitive functions and health-related quality of life in cirrhotic patients with minimal hepatic encephalopathy. Hepatology. 2007;45:549–59. - PubMed

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