Understanding the impact of neurologic complications in patients with cirrhosis.

Patients with cirrhosis may experience neurologic complications, including hepatic encephalopathy. Hepatic encephalopathy may be classified as covert (mild symptoms (e.g.

Recovery of cognitive function after sedation with propofol for outpatient gastrointestinal endoscopy.

Background/aim: Most endoscopies performed in the United States utilize sedation. Anesthesia provides patient comfort and improved procedural quality but adds to the complexity of scheduling routine outpatient procedures. We aimed to assess the return of cognitive function after propofol administration in patients undergoing outpatient endoscopies.

Diagnosis of covert hepatic encephalopathy: a multi-center study testing the utility of single versus combined testing.

Covert hepatic encephalopathy (CHE) affects cognition in a multidimensional fashion. Current guidelines recommend performing Psychometric Hepatic Encephalopathy Score (PHES) and a second test to diagnose CHE for multi-center trials. We aimed to determine if a two-test combination strategy improved CHE diagnosis agreement, and accuracy to predict overt hepatic encephalopathy (OHE), compared to single testing.

Hepatic Encephalopathy Is Associated with Persistent Learning Impairments Despite Adequate Medical Treatment: A Multicenter, International Study.

Background: Hepatic encephalopathy (HE) is considered reversible regarding mental status but may not be cognitively in single-center studies.

Aim: To evaluate persistence of learning impairment in prior HE compared to those who never experienced HE (no-HE) in a multicenter study.

Methods: A total of 174 outpatient cirrhotics from three centers (94 Virginia, 30 Ohio, and 50 Rome; 36 prior HE) underwent psychometric hepatic encephalopathy score (PHES) and inhibitory control (ICT) testing at baseline and then at least 7 days apart.

Optimal treatment of hepatic encephalopathy.

Hepatic encephalopathy (HE) is a complex neuropsychiatric syndrome associated with decompensated liver disease. The spectrum of disease ranges from trivial abnormalities in complex decision-making and prolonged reaction time to coma in its most severe form. The very initial stages, recently termed covert hepatic encephalopathy, can only be diagnosed with the help of neuropsychiatric testing, while the later and more severe forms, termed overt hepatic encephalopathy, can be diagnosed clinically.

Long-Term Management of Alcoholic Liver Disease.

The key to management of alcoholic liver disease (ALD) is early recognition by the patient and physician. Excessive alcohol consumption, ranging from drinking more than recommended amounts to abuse, is one of the most preventable causes of death and disability. The US Preventive Services Task Force guidelines recommend screening for alcoholism in the primary care setting.

Non-alcoholic fatty liver disease: What's in our arsenal?

Lifestyle changes and metabolic syndrome management are the best interventions for NAFLD. Less clear is which agents to use for liver-directed pharmacotherapy.

Diagnosis of Minimal Hepatic Encephalopathy Using Stroop EncephalApp: A Multicenter US-Based, Norm-Based Study.

Objectives: Diagnosing minimal hepatic encephalopathy (MHE) is challenging, and point-of-care tests are needed. Stroop EncephalApp has been validated for MHE diagnosis in single-center studies. The objective of the study was to validate EncephalApp for MHE diagnosis in a multicenter study.

Hypovitaminosis D is associated with increased whole body fat mass and greater severity of non-alcoholic fatty liver disease.

Background & Aims: Hypovitaminosis D is common in obesity and insulin-resistant states. Increased fat mass in patients with non-alcoholic fatty liver disease (NAFLD) may contribute to hypovitaminosis D. To determine the relation among plasma vitamin D concentration, severity of disease and body composition in NAFLD.

Cognitive dysfunction is associated with poor socioeconomic status in patients with cirrhosis: an international multicenter study.

Background & Aims: In patients with cirrhosis, cognitive dysfunction most often results from covert hepatic encephalopathy (HE). These patients are not tested routinely for cognitive dysfunction despite single-center evidence that it could be associated with poor socioeconomic status (SES). We investigated the association between SES and cognition in a multicenter study of cirrhosis.