HEPATIC ENCEPHALOPATHY IN CHRONIC LIVER DISEASE PRODUCED BY CHRONIC VIRAL HEPATITIS
Background: Hepatic encephalopathy (HE) involves neuropsychiatric dysfunction as a result of metabolic disturbance. The objective of the study was to determine and compare grades of hepatic encephalopathy in patients of viral hepatitis B, C, and co-infection. Methods: A cross-sectional study was designed which included seventy five patients of chronic HBV, HCV, and co-infection of either sex, aged 35 years or above. The patients were equally divided into 3 groups. Hepatic encephalopathy was classified into four grades based on the West Haven classification. Results: Out of the 75 subjects, 51 (68.0%) were males and 24 (32.0%) were females. The Mean age was 44.69±7.423 years. Grade I hepatic encephalopathy was a significant feature of both chronic HCV and co-infection groups. The development of grade II encephalopathy was more marked in chronic HBV group, while grade III encephalopathy was more frequent in chronic HCV group. However, frequency distribution of grade IV encephalopathy remained same in all groups. Conclusion: The study concluded that progression of encephalopathy was not more marked in co-infection group. In fact, hepatic encephalopathy equally developed in study groups.
Keywords: Chronic liver disease, Hepatic encephalopathy, viral hepatitis
Pak J Physiol 2017;13(2):38–40
2. Sanyal AJ, Mullen KD, Bass NM. The treatment of hepatic encephalopathy in the cirrhotic patient. Gastroenterol Hepatol (NY) 2010;6(4 Suppl 8):1–12.
3. Mullen KD. The treatment of patients with hepatic encephalopathy: Review of the latest data from EASL 2010. Gastroenterol Hepatol (NY) 2010;6(7):1–16.
4. Bass NM, Mullen KD, Sanyal A, Poordad F, Neff G, Leevy CB, et al. Rifaximin treatment in hepatic encephalopathy. N Engl J Med 2010;362:1071–81.
5. Silva AS, Santos LL, Passos AD, Sankarankutty AK, Martinelli Ade L, Silva Ode C. Chronic liver disease prevention strategies and liver transplantation. Acta Cir Bras 2006;21(Suppl 1):79–84.
6. Orenbuch-Harroch E, Levy L, Ben-Chetrit E. Acute hepatitis B or exacerbation of chronic hepatitis B-that is the question. World J Gastroenterol 2008;14:7133–7.
7. Baig S, Siddiqui AA, Ahmed W, Qureshi H, Arif A. The association of complex liver disorders with HBV genotypes prevalent in Pakistan. Virol J 2007;4:128.
8. Shoukry NH, Cawthon AG, Walker CM. Cell-mediated immunity and the outcome of hepatitis C virus infection. Ann Rev Microbiol 2004;58:391–424.
9. Vince, A. Hepatitis B and C: natural course of disease. Acta Med Croatica 2005;59:389–92.
10. Park JS, Saraf N, Dieterich DT. HBV plus HCV, HCV plus HIV, HBV plus HIV. Curr Gastroenterol Rep 2006;8(1):67–74.
11. Chu CJ, Lee SD. Hepatitis B virus/hepatitis C virus coinfection: epidemiology, clinical features, viral interactions and treatment. J Gastroenterol Hepatol 2008;23:512–20.
12. Seyan AS, Hughes RD, Shawcross DL. Changing face of hepatic encephalopathy: Role of inflammation and oxidative stress. World J Gastroenterol 2010;16:3347–57.
13. McPhail MJ, Bajaj JS, Thomas HC, Taylor-Robinson SD. Pathogenesis and diagnosis of hepatic encephalopathy. Expert Rev Gastroenterol Hepatol 2010;4:365–78.
14. Bismuth M, Funakoshi N, Cadranel JF, Blanc P. Hepatic encephalopathy: From pathophysiology to therapeutic management. Eur J Gastroenterol Hepatol 2011;23(1):8–22.
15. Butterworth RF. Editorial: Rifaximin and minimal hepatic encephalopathy. Am J Gastroenterol 2011;106:317–8.
16. Munoz SJ. Hepatic encephalopathy. Med Clin North Am 2008;92:795–812.
17. Sureka B, Bansal K, Patidar Y, Rajesh S, Mukund A, Arora A. Neurologic manifestations of chronic liver disease and liver cirrhosis. Curr Probl Diagn Radiol 2015;44:449–61.
18. Wright G, Noiret L, Olde Damink SW, Jalan R. Interorgan ammonia metabolism in liver failure: The basis of current and future therapies. Liver Int 2011;31(2):163–75.
19. Montagnese S, Biancardi A, Schiff S, Carraro P, Carlà V, Mannaioni G, et al. Different biochemical correlates for different neuropsychiatric abnormalities in patients with cirrhosis. Hepatology 2011;53:558–66.
20. Burkitt HG, Young B, Heath JW, (Eds). Wheater’s Functional histology: a text and color atlas. 3rd ed. Edinburgh: Churchill Livingston; 1993. p. 11–39.
21. Bukhtiari N, Hussain T, Iqbal M, Malik AM, Qureshi AH, Hussain A. Hepatitis B and C single and co-infection in chronic liver disease and their effect on the disease pattern. J Pak Med Assoc 2003;53:136–40.
22. Castillo I, Rodríguez-Inigo E, Lopez-Alcorocho JM, Bartolome J, Pardo M, Carreno V. Comparative study on the clinical and virological characteristics among patients with single occult hepatitis B virus (HBV), single occult hepatitis C virus (HCV) and occult HBV and HCV dual infection. J Med Virol 2007;79:236–41.
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