EncephalApp Stroop Test validation for the screening of minimal hepatic encephalopathy in Brazil

Cunha‐Silva, Marlone; Neto, Fernando Lopes Ponte; Araújo, Priscila S. de; Pazinato, Lucas Vatanabe; Greca, Raquel Dias; Secundo, Tirzah M.L.; Imbrizi, Marcello; Monici, Leonardo Trevizan; Sevá‐Pereira, Tiago; Mazo, Daniel Ferraz de Campos

doi:10.1016/j.aohep.2021.100543

Cited by 8 publications

(8 citation statements)

References 23 publications

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“…In Bajaj 2019, patients who received FMT had a clinically significant improvement in Encephalapp performance compared to those receiving SOC (p = 0.02) [9]. In Mehta 2018, patients with HE receiving FMT had a statistically significant reduction in CTP score 9.5 (9-10.75) vs. 8 (7)(8) and MELD 18 (16.25-19) vs. 15 (14)(15)(16) [11].…”

Section: Resultsmentioning

confidence: 99%

“…EncephalApp Stroop test is a validated App-based version of the Stroop test [ 15 ]. Similarly to PHES, the Stroop test also evaluates cognitive flexibility and psychomotor speed [ 16 ]. It consists of two stages: the “ON” stage where the participant names the color of the pound signs, and the “OFF” stage where the participant states the color of a discordant word [ 16 ].…”

Section: Methodsmentioning

confidence: 99%

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Fecal Microbiota Transplantation in Decompensated Cirrhosis: A Systematic Review on Safety and Efficacy

et al. 2022

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Background and Aims: Due to increasing knowledge of the “gut–liver axis”, there has been growing interest regarding the use of fecal microbiota transplant in the management of chronic liver disease. There are limited data available and current guidelines are mostly based on expert opinions. We aim to perform the first systematic review investigating safety and efficacy of fecal microbiota transplant particularly among high-risk decompensated cirrhosis patient populations. Methods: Literature search was performed using variations of the keywords “fecal microbiota transplant” and “cirrhosis” on PubMed/Medline from inception to 3 October 2021. The resulting 116 articles were independently screened by two authors. In total, 5 qualifying studies, including 2 randomized control trials and 3 retrospective case series, were found to meet established eligibility criteria and have adequate quality of evidence to be included in this review. Results: Of the total 58 qualifying patients, there were 2 deaths post fecal microbiota transplant, 1 of which could not rule out being related (1.7%). Among the remaining 56 participants, 8 serious adverse events were reported, of which 2 could not rule out being related (3.6%). The success rate of fecal microbiota transplantation in treating recurrent Clostridioides difficile infection among patients with decompensated cirrhosis was 77.8%. The success rate when used as investigational treatment for hepatic encephalopathy was 86.7%, with multiple studies reporting clinically significant improvement in encephalopathy testing scores. Conclusions: We found a marginally higher rate of deaths and serious adverse events from fecal microbiota transplant in our patient population compared with the average immunocompetent population, where it was previously found to have 0 deaths and SAE rate of 2.83%. The efficacy when used for recurrent C.difficile infection was 77.8% and 87% in the decompensated cirrhotic and general populations, respectively. Studies on efficacy in novel treatment of hepatic encephalopathy have been promising. This study concludes that fecal microbiota transplant use in decompensated cirrhosis patients should be used with caution and preferably be limited to research purposes until better data are available.

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Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Fecal Microbiota Transplantation in Decompensated Cirrhosis: A Systematic Review on Safety and Efficacy

et al. 2022

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“…The primary endpoints of the systematic review are the efficacy and safety of FMT in treating hepatic encephalopathy and C. difficile infection. In patients with hepatic encephalopathy, the efficacy is determined by the patient’s performance on cognitive tests, such as Psychometric Hepatic Encephalopathy Score (PHES) and EncephalApp Stroop test [ 18 - 20 ]. PHES is derived from five component tests: number connection test-A, number connection test-B, serial dotting test, line tracing test, and digit symbol test.…”

Section: Reviewmentioning

confidence: 99%

“…It evaluates skills, such as attention, psychomotor function, and visual perception [ 21 ]. PHES has been validated as the gold standard for the diagnosis of hepatic encephalopathy as a patient’s performance on PHES has been demonstrated to be representative of his or her cerebral function [ 19 , 20 ]. A score that is mathematically lower than -4 is associated with hepatic encephalopathy and worse cognitive performance.…”

Section: Reviewmentioning

confidence: 99%

“…Similar to PHES, the Stroop test also evaluates cognitive flexibility and psychomotor speed [ 19 ]. It consists of two stages: the “ON” stage in which the participant names the color of the pound signs, and the “OFF” stage in which the participant states the color of a discordant word [ 18 , 20 ]. If the time taken for both ON and OFF stages is longer than 269.8 seconds, it has been determined that a diagnosis of hepatic encephalopathy can be made with sufficient sensitivity and specificity [ 18 , 20 ].…”

Section: Reviewmentioning

confidence: 99%

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A Systematic Review of the Efficacy and Safety of Fecal Microbiota Transplantation in the Treatment of Hepatic Encephalopathy and Clostridioides difficile Infection in Patients With Cirrhosis

Tun¹,

Hong²,

Batra³

et al. 2022

Cureus

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A shortened Stroop test to identify covert hepatic encephalopathy and predict overt hepatic encephalopathy in patients with cirrhosis

et al. 2022

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EncephalApp Stroop Test validation for the screening of minimal hepatic encephalopathy in Brazil

Cited by 8 publications

References 23 publications

Fecal Microbiota Transplantation in Decompensated Cirrhosis: A Systematic Review on Safety and Efficacy

Fecal Microbiota Transplantation in Decompensated Cirrhosis: A Systematic Review on Safety and Efficacy

A Systematic Review of the Efficacy and Safety of Fecal Microbiota Transplantation in the Treatment of Hepatic Encephalopathy and Clostridioides difficile Infection in Patients With Cirrhosis

A shortened Stroop test to identify covert hepatic encephalopathy and predict overt hepatic encephalopathy in patients with cirrhosis

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