Subclinical hepatic encephalopathy: Detection, prevalence, and relationship to nitrogen metabolism

Rikkers, Layton F.; Jenko, Paul G.; Rudman, Daniel; Freides, David

doi:10.1016/0016-5085(78)90851-x

Cited by 293 publications

(110 citation statements)

References 20 publications

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“…As many as 60% of patients with liver cirrhosis and no clinical signs of encephalopathy will have abnormalities in number connection testing (11). Time to complete the number connection test has also been found to be significantly prolonged in cirrhotics compared with controls (P < 0.01) (5).…”

Section: Discussionmentioning

confidence: 97%

Breath Ammonia Testing for Diagnosis of Hepatic Encephalopathy

et al. 2005

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Measurement of arterial ammonia has been used as a diagnostic test for hepatic encephalopathy, but obtaining an arterial specimen is an invasive procedure. The aim of this study was to evaluate the ability of a minimally invasive, highly sensitive optical sensing device to detect ammonia in the breath of patients with end-stage liver disease and to evaluate the correlation of breath ammonia levels, arterial ammonia levels, and psychometric testing. Fifteen subjects with liver cirrhosis and clinical evidence of hepatic encephalopathy underwent mini-mental status examination, number connection test, focused neurological examination, and arterial ammonia testing. On the same day, breath ammonia testing was performed using an apparatus that consists of a sensor (a thin membrane embedded with a pH-sensitive dye) attached to a fiberoptic apparatus that detects optical absorption. Helicobacter pylori testing was performed using the 14C urea breath test. A positive correlation was found between arterial ammonia level and time to complete the number connection test (r = 0.31, P = 0.03). However, a negative correlation was found between breath ammonia level and number connection testing (r = -0.55, P = 0.03). Furthermore, no correlation was found between breath and arterial ammonia levels (r = -0.005, P = 0.98). There is a significant correlation between the trailmaking test and arterial ammonia levels in patients with cirrhosis. However, no correlation was found between breath and arterial ammonia levels using the fiberoptic ammonia sensor apparatus in this small study.

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Section: Discussionmentioning

confidence: 97%

Breath Ammonia Testing for Diagnosis of Hepatic Encephalopathy

et al. 2005

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“…From the moment barely 30 years ago when Rikkers et al [1] first reported the detection and prevalence of subclinical hepatic encephalopathy, this issue has remained controversial. The term latent, or subclinical, was used largely because of a lack of clearly identifiable clinical manifestations of the disease.…”

Section: See Article Pages 67-73mentioning

confidence: 98%

Critical flicker frequency: It is time to break down barriers surrounding minimal hepatic encephalopathy

Romero‐Gómez

2007

Journal of Hepatology

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“…However, a significant proportion of cirrhotic patients, which appear normal on clinical examination, may exhibit neuropsychological deficits, when subjected to selected neuropsychological test batteries [4][5][6][7][8][9][10][11][12][13]. This condition was termed minimal hepatic encephalopathy (mHE), which by definition cannot be picked up by WestHaven-criteria [4][5][6][7][8][9][10][11][12][13].…”

Section: Introductionmentioning

confidence: 99%