Hepatic Encephalopathy

Publication Title: 
The American Journal of Gastroenterology

OBJECTIVES: Cirrhosis and hepatic encephalopathy (HE) can adversely affect survival, but their effect on socioeconomic and emotional burden on the family is not clear. The aim was to study the emotional and socioeconomic burden of cirrhosis and HE on patients and informal caregivers. METHODS: A cross-sectional study in two transplant centers (Veterans and University) of cirrhotic patients and their informal caregivers was performed. Demographics for patient/caregivers, model-for-end-stage liver disease (MELD) score, and cirrhosis complications were recorded.

Author(s): 
Bajaj, Jasmohan S.
Wade, James B.
Gibson, Douglas P.
Heuman, Douglas M.
Thacker, Leroy R.
Sterling, Richard K.
Stravitz, R. Todd
Luketic, Velimir
Fuchs, Michael
White, Melanie B.
Bell, Debulon E.
Gilles, Hochong
Morton, Katherine
Noble, Nicole
Puri, Puneet
Sanyal, Arun J.
Publication Title: 
American Journal of Physiology. Gastrointestinal and Liver Physiology

Hepatic encephalopathy (HE) has been related to gut bacteria and inflammation in the setting of intestinal barrier dysfunction. We aimed to link the gut microbiome with cognition and inflammation in HE using a systems biology approach. Multitag pyrosequencing (MTPS) was performed on stool of cirrhotics and age-matched controls. Cirrhotics with/without HE underwent cognitive testing, inflammatory cytokines, and endotoxin analysis. Patients with HE were compared with those without HE using a correlation-network analysis.

Author(s): 
Bajaj, Jasmohan S.
Ridlon, Jason M.
Hylemon, Phillip B.
Thacker, Leroy R.
Heuman, Douglas M.
Smith, Sean
Sikaroodi, Masoumeh
Gillevet, Patrick M.
Publication Title: 
Hepatology (Baltimore, Md.)

Minimal hepatic encephalopathy (MHE) in cirrhosis is associated with impaired driving skills and increased risk of motor vehicle accidents (MVAs). Detection and treatment of MHE has the potential to reduce costs and morbidity associated with MVAs. We conducted a cost-effectiveness analysis to assess the benefits of different strategies of MHE diagnosis and treatment for reducing MVA-related societal costs.

Author(s): 
Bajaj, Jasmohan S.
Pinkerton, Steven D.
Sanyal, Arun J.
Heuman, Douglas M.
Publication Title: 
Clinics in Liver Disease

Minimal hepatic encephalopathy (MHE) is associated with a high risk of development of overt hepatic encephalopathy, impaired quality of life, and driving accidents. The detection of MHE requires specialized testing because it cannot, by definition, be diagnosed on standard clinical examination. Psychometric and neurophysiologic techniques are often used to test for MHE. Paper-pencil psychometric batteries and computerized tests have proved useful in diagnosing MHE and predicting its outcomes. Neurophysiologic tests also provide useful information.

Author(s): 
Kappus, Matthew R.
Bajaj, Jasmohan S.
Publication Title: 
Alimentary Pharmacology & Therapeutics

BACKGROUND: The subjectivity of the West-Haven criteria (WHC) hinders hepatic encephalopathy (HE) evaluation. The new HE classification has emphasised assessment of orientation. The modified-orientation log (MO-log, eight questions, scores 0-24; 24 normal) is adapted from a validated brain injury measure. AIM: To validate MO-log for HE assessment in cirrhosis. METHODS: Cirrhotics admitted with/without HE were administered MO-log.

Author(s): 
Salam, M.
Matherly, S.
Farooq, I. S.
Stravitz, R. T.
Sterling, R. K.
Sanyal, A. J.
Gibson, D. P.
Wade, J. B.
Thacker, L. R.
Heuman, D. M.
Fuchs, M.
Puri, P.
Luketic, V.
Bickston, S. J.
Bajaj, J. S.
Publication Title: 
Liver Transplantation: Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society

Psychiatric disorders and medications may affect the cognitive performance of patients with cirrhosis and complicate the diagnosis and prediction of hepatic encephalopathy (HE). The aim of this study was to study the association of psychoactive medications with cognitive performance and their effects on the ability of tests to predict HE development in patients with cirrhosis referred for transplant evaluation. Cirrhosis details, psychiatric disorders, psychoactive medications, and any history of prior HE were recorded for patients with cirrhosis at 2 transplant centers.

Author(s): 
Bajaj, Jasmohan S.
Thacker, Leroy R.
Heuman, Douglas M.
Sterling, Richard K.
Stravitz, R. Todd
Sanyal, Arun J.
Luketic, Velimir
Fuchs, Michael
Gilles, Ho Chong S.
Wade, James B.
Publication Title: 
American Journal of Physiology. Gastrointestinal and Liver Physiology

Although hepatic encephalopathy (HE) is linked to the gut microbiota, stool microbiome analysis has not found differences between HE and no-HE patients. This study aimed to compare sigmoid mucosal microbiome of cirrhotic patients to controls, between HE vs. no-HE patients, and to study their linkage with cognition and inflammation. Sixty cirrhotic patients (36 HE and 24 no-HE) underwent cognitive testing, stool collection, cytokine (Th1, Th2, Th17, and innate immunity), and endotoxin analysis. Thirty-six patients (19 HE and 17 no-HE) and 17 age-matched controls underwent sigmoid biopsies.

Author(s): 
Bajaj, Jasmohan S.
Hylemon, Phillip B.
Ridlon, Jason M.
Heuman, Douglas M.
Daita, Kalyani
White, Melanie B.
Monteith, Pamela
Noble, Nicole A.
Sikaroodi, Masoumeh
Gillevet, Patrick M.
Publication Title: 
Journal of Hepatology

BACKGROUND & AIMS: Asymmetric dimethylarginine (ADMA) is an inhibitor of nitric oxide synthase that accumulates in liver disease and may contribute to hepatic encephalopathy (HE). We aimed at evaluating the association of ADMA with cognition and brain MR spectroscopy (MRS) in cirrhosis. METHODS: Cirrhotic patients with/without prior HE and non-cirrhotic controls underwent cognitive testing and ADMA determination. A subgroup underwent brain MRS [glutamine/glutamate (Glx), myoinositol (mI), N-acetyl-aspartate (NAA) in parietal white, occipital gray, and anterior cingulated (ACC)].

Author(s): 
Bajaj, Jasmohan S.
Ahluwalia, Vishwadeep
Wade, James B.
Sanyal, Arun J.
White, Melanie B.
Noble, Nicole A.
Monteith, Pamela
Fuchs, Michael
Sterling, Richard K.
Luketic, Velimir
Bouneva, Iliana
Stravitz, Richard T.
Puri, Puneet
Kraft, Kenneth A.
Gilles, Hochong
Heuman, Douglas M.
Publication Title: 
Hepatology (Baltimore, Md.)

Minimal hepatic encephalopathy (MHE) detection is difficult because of the unavailability of short screening tools. Therefore, MHE patients can remain undiagnosed and untreated. The aim of this study was to use a Stroop smartphone application (app) (EncephalApp_Stroop) to screen for MHE.

Author(s): 
Bajaj, Jasmohan S.
Thacker, Leroy R.
Heuman, Douglas M.
Fuchs, Michael
Sterling, Richard K.
Sanyal, Arun J.
Puri, Puneet
Siddiqui, Mohammad S.
Stravitz, Richard T.
Bouneva, Iliana
Luketic, Velimir
Noble, Nicole
White, Melanie B.
Monteith, Pamela
Unser, Ariel
Wade, James B.
Publication Title: 
PloS One

Hepatic encephalopathy (HE) represents a dysfunctional gut-liver-brain axis in cirrhosis which can negatively impact outcomes. This altered gut-brain relationship has been treated using gut-selective antibiotics such as rifaximin, that improve cognitive function in HE, especially its subclinical form, minimal HE (MHE). However, the precise mechanism of the action of rifaximin in MHE is unclear. We hypothesized that modulation of gut microbiota and their end-products by rifaximin would affect the gut-brain axis and improve cognitive performance in cirrhosis.

Author(s): 
Bajaj, Jasmohan S.
Heuman, Douglas M.
Sanyal, Arun J.
Hylemon, Phillip B.
Sterling, Richard K.
Stravitz, R. Todd
Fuchs, Michael
Ridlon, Jason M.
Daita, Kalyani
Monteith, Pamela
Noble, Nicole A.
White, Melanie B.
Fisher, Andmorgan
Sikaroodi, Masoumeh
Rangwala, Huzefa
Gillevet, Patrick M.

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