Diagnóstico y tratamiento de la encefalopatía hepática mínima. Una revisión narrativa
DOI:
https://doi.org/10.59093/27112330.131Palabras clave:
encefalopatía hepática, cirrosis hepática, pruebas neuropsicológicas, lactulosa, rifaximina.Resumen
La encefalopatía hepática es una de las complicaciones más frecuentes de la cirrosis y de otras formas de hipertensión portal. Sin embargo, su espectro de presentación es notoriamente amplio, y la forma subclínica, la encefalopatía hepática mínima (EHM), complica el diagnóstico. La forma mínima afecta notablemente la calidad de vida y es un predictor de progresión a una forma manifiesta, así como de hospitalización y mortalidad. El diagnóstico de la EHM se sustenta en pruebas psicométricas con el Psychometric Hepatic Encephalopathy Score como el estándar de oro, aunque subrogados como el Stroop Test y el Animal Naming Test se perfilan como pruebas de menor complejidad logística. La evidencia actual, con moderada a alta certeza, permite concluir que la lactulosa y la rifaximina impactan positivamente en desenlaces clínicamente relevantes en la EHM. La L-ornitina-L-aspartato y los probióticos se postulan como alternativas razonables.
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Referencias bibliográficas
Hurtado-Díaz-de-León I, Tapper EB. Systems of care that improve outcomes for people with hepatic encephalopathy. Metab Brain Dis 2024;40:50. https://doi.org/10.1007/s11011-024-01430-8.
Faccioli J, Nardelli S, Gioia S, Riggio O, Ridola L. Minimal hepatic encephalopathy affects daily life of cirrhotic patients: a viewpoint on clinical consequences and therapeutic opportunities. J Clin Med 2022;11:7246. https://doi.org/10.3390/jcm11237246.
Conn HO, Leevy CM, Vlahcevic ZR, Rodgers JB, Maddrey WC, Seeff L. Comparison of lactulose and neomycin in the treatment of chronic portal systemic encephalopathy. A double blind controlled trial. Gastroenterology 1977;72: 573-583.
Redfield R, Latt N, Munoz SJ. Minimal hepatic encephalopathy. Clinics in liver disease 2024;28:237-252. https://doi.org/10.1016/j.cld.2024.01.004.
Lv XH, Lu Q, Deng K, et al. Prevalence and characteristics of covert/minimal hepatic encephalopathy in patients with liver cirrhosis: a systematic review and meta-analysis. Am J Gastroenterol 2024;119:690-699. https://doi.org/10.14309/ajg.0000000000002563.
Elsaid MI, Rustgi VK. Epidemiology of hepatic encephalopathy. Clin Liver Dis 2020;24:157-174. https://doi.org/10.1016/j.cld.2020.01.001.
Groeneweg M, Quero JC, De Bruijn I, Hartmann IJ, Essink-bot ML, Hop WC. Subclinical hepatic encephalopathy impairs daily functioning. Hepatology 1998;28:45-49. https://doi.org/10.1002/hep.510280108.
Bajaj JS. Minimal hepatic encephalopathy matters in daily life. World J Gastroenterol 2008;14:3609-3615. https://doi.org/10.3748/wjg.14.3609.
Patidar KR, Thacker LR, Wade JB, Sterling RK, Sanyal AJ, Siddiqui MS, et al. Covert hepatic encephalopathy is independently associated with poor survival and increased risk of hospitalization. Am J Gastroenterol 2014;109:1757-1763. https://doi.org/10.1038/ajg.2014.264.
Dhiman RK, Kurmi R, Thumburu KK, et al. Diagnosis and prognostic significance of minimal hepatic encephalopathy in patients with cirrhosis of liver. Dig Dis Sci 2010;55:2381-2390. https://doi.org/10.1007/s10620-010-1249-7.
Sherlock S, Summerskill WH, White LP, Phear EA. Portal-systemic encephalopathy; neurological complications of liver disease. Lancet 1954;267:454-457.
Summerskill WH, Davidson EA, Sherlock S, Steiner RE. The neuropsychiatric syndrome associated with hepatic cirrhosis and an extensive portal collateral circulation. Q J Med 1956;25:245-266.
Zeegen R, Drinkwater JE, Dawson AM. Method for measuring cerebral dysfunction in patients with liver disease. Br Med J 1970;2:633-636. https://doi.org/10.1136/bmj.2.5710.633.
Weissenborn K, Ennen JC, Schomerus H, Rückert N, Hecker H. Neuropsychological characterization of hepatic encephalopathy. J Hepatol 2001;34:768-773. https://doi.org/10.1016/s0168-8278(01)00026-5.
Randolph C, Hilsabeck R, Kato A, Kharbanda P, Li YY, Mapelli D, et al. Neuropsychological assessment of hepatic encephalopathy: ISHEN practice guidelines. Liver Int 2009;29:629-635. https://doi.org/10.1111/j.1478-3231.2009.02009.x.
Schomerus H, Hamster W, Blunck H, Reinhard U, Mayer K, Dölle W. Latent portasystemic encephalopathy. I. Nature of cerebral functional defects and their effect on fitness to drive. Dig Dis Sci 1981;26:622-630. https://doi.org/10.1007/BF01367675.
Watanabe A, Tuchida T, Yata Y, Kuwabara Y. Evaluation of neuropsychological function in patients with liver cirrhosis with special reference to their driving ability. Metab Brain Dis 1995;10:239-248. https://doi.org/10.1007/BF02081029.
Srivastava A, Mehta R, Rothke SP, Rademaker AW, Blei AT. Fitness to drive in patients with cirrhosis and portal-systemic shunting: a pilot study evaluating driving performance. J Hepatol 1994;21:1023-1028. https://doi.org/10.1016/s0168-8278(05)80612-9.
Weissenborn, K. Hepatic encephalopathy: definition, clinical grading and diagnostic principles. Drugs 2019;79:5-9. https://doi.org/10.1007/s40265-018-1018-z.
Groeneweg M, Quero JC, De Bruijn I, Hartmann IJ, Essink-bot ML, Hop WC, Schalm SW. Subclinical hepatic encephalopathy impairs daily functioning. Hepatology 1998;28:45-49. https://doi.org/10.1002/hep.510280108.
Eftekar M. The association between hepatic encephalopathy/minimal hepatic encephalopathy and depressive and anxiety disorders: a systematic review. Australas Psychiatry 2020;28:61-65. https://doi.org/10.1177/1039856219875054.
Schomerus H, Hamster W. Neuropsychological aspects of portal-systemic encephalopathy. Metab Brain Dis 1998;13:361-377. https://doi.org/10.1023/a:1020645110880.
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;35:716-721. https://doi.org/10.1053/jhep.2002.31250.
Pinho M, Cerqueira R, Peixoto B. [Psychometric hepatic encephalopathy score normalization data for the Portuguese population]. Acta Med Port 2011;24:319-326.
Coubard OA, Ober KM, Gaumet M, Urbanski M, Amato JN, Chapron V, et al. Standardization of the psychometric hepatic encephalopathy score in a French population. PLoS One 2021;16: e0257136. https://doi.org/10.1371/journal.pone. 0257136.
Duarte-Rojo A, Estradas J, Hernández-Ramos R, Ponce-de-León S, Córdoba J, Torre A. Validation of the psychometric hepatic encephalopathy score (PHES) for identifying patients with minimal hepatic encephalopathy. Digestive diseases and sciences 2011;56:3014-3023. https://doi.org/10.1007/s10620-011-1684-0.
Padilla-Ruiz MA. Tablas de normalidad de la población en Cuba para los test psicométricos utilizados en el diagnóstico de la encefalopatía hepática mínima. Rev Gastroenterol Peru 2016;36:29-34.
Gairing SJ, Schleicher EM, Galle PR, Labenz C. Prediction and prevention of the first episode of overt hepatic encephalopathy in patients with cirrhosis. Hepatol Commun 2023;7:e0096. https://doi.org/10.1097/HC9.0000000000000096.
Dhiman RK, Thumburu KK, Verma N, Chopra M, Rathi S, Dutta U, et al. Comparative efficacy of treatment options for minimal hepatic encephalopathy: a systematic review and network meta-analysis. Clin Gastroenterol Hepatol 2020;18:800-812. https://doi.org/10.1016/j.cgh.2019.08.047.
Gluud LL, Vilstrup H, Morgan MY. Non-absorbable disaccharides versus placebo/no intervention and lactulose versus lactitol for the prevention and treatment of hepatic encephalopathy in people with cirrhosis. Cochrane Database Syst Rev 2016;4: CD003044. https://doi.org/10.1002/14651858.CD003044.pub3.
Moon AM, Kim HP, Jiang Y, Lupu G, Bissram JS, Barritt AS, et al. Systematic review and meta-analysis on the effects of lactulose and rifaximin on patient-reported outcomes in hepatic encephalopathy. Am J Gastroenterol 2023;118:284-293. https://doi.org/10.14309/ajg.0000000000002008.
Zacharias HD, Kamel F, Tan J, Kimer N, Gluud LL, Morgan MY. Rifaximin for prevention and treatment of hepatic encephalopathy in people with cirrhosis. Cochrane Database Syst Rev 2023;7:CD011585. https://doi.org/10.1002/14651858.CD011585.pub2.
Butterworth RF, Kircheis G, Hilger N, McPhail MJ. Efficacy of l-ornithine l-aspartate for the treatment of hepatic encephalopathy and hyperammonemia in cirrhosis: systematic review and meta-analysis of randomized controlled trials. J Clin Exp Hepatol 2018;8:301-313. https://doi.org/10.1016/j.jceh.2018.05.004.
He Q, Mao C, Chen Z, Zeng Y, Deng Y, Hu R. Efficacy of L-ornithine L-aspartate for minimal hepatic encephalopathy in patients with cirrhosis: A meta-analysis of randomized controlled trials. Arab J Gastroenterol 2024;25:84-92. https://doi.org/10.1016/j.ajg.2024.01.006.
Wibawa IDN, Mariadi IK, Shalim CP, Sindhughosa DA. Efficacy of probiotics in the treatment of minimal hepatic encephalopathy: A systematic review and meta-analysis. J Clin Exp Hepatol 2023;9:146-153. https://doi.org/10.5114/ceh.2023.128768.
Cao Q, Yu CB, Yang SG, Cao HC, Chen P, Deng M, et al. Effect of probiotic treatment on cirrhotic patients with minimal hepatic encephalopathy: A meta-analysis. Hepatobiliary Pancreat Dis Int 2018;17:9-16. https://doi.org/10.1016/j.hbpd.2018.01.005.
Viramontes HD, Avery A, Stow R. The effects of probiotics and symbiotics on risk factors for hepatic encephalopathy: a systematic review. J Clin Gastroenterol 2017;51:312-323. https://doi.org/10.1097/MCG.0000000000000789.
Ruszkowski J, Witkowski JM. Lactulose: Patient- and dose-dependent prebiotic properties in humans. Anaerobe 2019;59:100-106. https://doi.org/10.1016/j.anaerobe.2019.06.002.
Yang W, Guo G, Sun C. Therapeutic potential of rifaximin in liver diseases. Biomed Pharmacother 2024;178:117283. https://doi.org/10.1016/j.biopha.2024.117282.
Martí-Carvajal AJ, Gluud C, Arévalo-Rodríguez I, Martí-Amarista CE. Acetyl-L-carnitine for patients with hepatic encephalopathy. Cochrane Database Syst Rev 2019;1:CD011451. https://doi.org/10.1002/14651858.CD011451.pub2.
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