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High prevalence of spontaneous portal‐systemic shunts in persistent hepatic encephalopathy: A case‐control study
Author(s) -
Riggio Oliviero,
Efrati Cesare,
Catalano Carlo,
Pediconi Federica,
Mecarelli Oriano,
Accornero Neri,
Nicolao Francesca,
Angeloni Stefania,
Masini Andrea,
Ridola Lorenzo,
Attili Adolfo F.,
Merli Manuela
Publication year - 2005
Publication title -
hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.488
H-Index - 361
eISSN - 1527-3350
pISSN - 0270-9139
DOI - 10.1002/hep.20905
Subject(s) - medicine , cirrhosis , hepatic encephalopathy , ascites , esophageal varices , portal venous pressure , gastroenterology , magnetic resonance imaging , portal hypertension , encephalopathy , radiology
Large spontaneous portal‐systemic shunts have been occasionally described in patients with cirrhosis. This study was undertaken to assess the prevalence of portal‐systemic shunts in patients with cirrhosis with recurrent or persistent hepatic encephalopathy (HE) as compared with patients with cirrhosis without HE. Fourteen patients with cirrhosis with recurrent or persistent HE (cases) and 14 patients with cirrhosis without previous or present signs of overt HE matching for age and degree of liver failure (controls) were studied. Each patient underwent neurological assessment and cerebral magnetic resonance (MR) imaging to exclude organic neurological pathological conditions. HE evaluation included psychometric performance (Trail‐Making Test A), electroencephalogram (EEG), mental status examination and grading, arterial, venous, and partial pressure of ammonia determination. The presence of portal‐systemic shunts was assessed by portal venous phase multidetector‐row spiral computed tomography (CT). Large spontaneous portal‐systemic shunts were detected in 10 patients with HE and in only 2 patients without HE (71% vs. 14%; chi square = 9.16; df = 1.0; P = .002). The patients with HE presented ascites ( P = .002) and medium/large esophageal varices ( P = .02) less frequently than the control group. In conclusion , our study suggests that large spontaneous shunts may often sustain the chronicity of HE; the presence of large shunts should be sought in patients with cirrhosis with recurrent or persistent HE. (H EPATOLOGY 2005;42:1158–1165.)