Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

Improving quality of life for patients with cirrhosis

05.03.2007
Medication improves cognitive function and quality of life in patients with minimal hepatic encephalopathy

A study on patients with cirrhosis who had minimal hepatic encephalopathy (MHE), a condition in which behavioral, psychological and neurological changes are associated with advanced liver disease, found that cognitive function and health related quality-of-life improved when they took lactulose. Lactulose is a drug used to help eliminate toxins such as ammonia that are normally cleared by the liver.

The results of this study appear in the March 2007 issue of Hepatology, the official journal of the American Association for the Study of Liver Diseases (AASLD). Published by John Wiley & Sons, Inc., Hepatology is available online via Wiley InterScience at http://www.interscience.wiley.com/journal/hepatology.

MHE is the mildest form of hepatic encephalopathy (HE), a condition marked by impaired intellectual functioning, personality changes, altered levels of consciousness, and neuromuscular dysfunction. Although MHE has no recognizable symptoms, patients who have it show mild cognitive and psychomotor deficits. These can impair their daily functioning and health related quality-of-life (HRQOL) to the extent that they may not be able to work or drive a car. MHE can also lead to the development of more severe HE, and can be associated with a poor prognosis.

Led by Radha K. Dhiman, MD, DM, MNAMS, FACG, of the Department of Hepatology, Postgraduate Institute of Medical Education and Research in Chandigarh, India, researchers conducted a study involving 61 patients who had MHE. The patients were diagnosed with MHE if they had abnormal scores on two or more neuropsychological tests that were used to assess their mental state. The patients were also given a Sickness Impact Profile (SIP) questionnaire to determine the impact of the disease on daily activities such as sleep/rest, eating, work, home management, mobility, social interaction and emotional behavior and communication. They were then divided into two groups: 31 patients received lactulose treatment for 3 months, while 30 patients received no treatment.

The results showed that the number of abnormal neuropsychological tests decreased among patients who took lactulose compared to those who did not. Changes in these tests indicating significant improvement in cognitive function were also seen in the lactulose group. In addition, the lactulose group also showed improvement in their quality of life as measured by SIP scores, with significant improvement in emotional behavior, movement, mobility, sleep/rest, and recreational activities.

The study also confirms the negative impact of MHE on HRQOL: patients showed impairment in perception, memory, learning, expression, mental activity and executive function. Other studies have shown that half of MHE patients do not have regular employment and that it has a negative effect on the ability to drive. "These observations strongly suggest that MHE should be considered a medical condition that might warrant treatment in order to improve psychomotor impairment and HRQOL," the authors state.

Ammonia is the key factor in HE and although the study did not measure ammonia levels, the authors believe that this is also the case with MHE. They chose lactulose since it is inexpensive, easily available and is effective at reducing ammonia levels in the blood. The authors conclude that cirrhosis patients with MHE may benefit from treatment with lactulose, adding: "Whether treatment also prevents or delays progression to overt HE and improves prognosis, remains to be determined in prospective studies."

In an accompanying editorial in the same issue, Asif Qadri and colleagues from MetroHealth Medical Center affiliated with Case Western Reserve University in Cleveland, OH state that the current study "may potentially change the overall management of hepatic encephalopathy (HE)," adding that the results strongly suggest that MHE is the cause of reduced quality-of-life in patients with cirrhosis. While studies need to be done to confirm these findings, Dhiman et al. also note that the study highlights some interesting questions that could be answered in future studies, such as whether early treatment of HE can postpone worsening symptoms for longer periods of time, and whether it impacts survival. Although the results support the ability of lactulose as a treatment for HE, there are significant barriers to widespread diagnosis of MHE, the authors point out. They suggest that measures need to be taken to simplify the diagnosis of MHE, or alternatively, it may emerge that all cirrhotic patients will eventually develop MHE, making its treatment the standard of care and eliminating the need to determine if it is actually present. "In any event," they conclude, "it appears that we cannot ignore minimal hepatic encephalopathy any longer."

Amy Molnar | EurekAlert!
Further information:
http://www.interscience.wiley.com/journal/hepatology

More articles from Studies and Analyses:

nachricht The personality factor: How to foster the sharing of research data
06.09.2017 | ZBW – Leibniz-Informationszentrum Wirtschaft

nachricht Europe’s Demographic Future. Where the Regions Are Heading after a Decade of Crises
10.08.2017 | Berlin-Institut für Bevölkerung und Entwicklung

All articles from Studies and Analyses >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Tiny lasers from a gallery of whispers

New technique promises tunable laser devices

Whispering gallery mode (WGM) resonators are used to make tiny micro-lasers, sensors, switches, routers and other devices. These tiny structures rely on a...

Im Focus: Ultrafast snapshots of relaxing electrons in solids

Using ultrafast flashes of laser and x-ray radiation, scientists at the Max Planck Institute of Quantum Optics (Garching, Germany) took snapshots of the briefest electron motion inside a solid material to date. The electron motion lasted only 750 billionths of the billionth of a second before it fainted, setting a new record of human capability to capture ultrafast processes inside solids!

When x-rays shine onto solid materials or large molecules, an electron is pushed away from its original place near the nucleus of the atom, leaving a hole...

Im Focus: Quantum Sensors Decipher Magnetic Ordering in a New Semiconducting Material

For the first time, physicists have successfully imaged spiral magnetic ordering in a multiferroic material. These materials are considered highly promising candidates for future data storage media. The researchers were able to prove their findings using unique quantum sensors that were developed at Basel University and that can analyze electromagnetic fields on the nanometer scale. The results – obtained by scientists from the University of Basel’s Department of Physics, the Swiss Nanoscience Institute, the University of Montpellier and several laboratories from University Paris-Saclay – were recently published in the journal Nature.

Multiferroics are materials that simultaneously react to electric and magnetic fields. These two properties are rarely found together, and their combined...

Im Focus: Fast, convenient & standardized: New lab innovation for automated tissue engineering & drug

MBM ScienceBridge GmbH successfully negotiated a license agreement between University Medical Center Göttingen (UMG) and the biotech company Tissue Systems Holding GmbH about commercial use of a multi-well tissue plate for automated and reliable tissue engineering & drug testing.

MBM ScienceBridge GmbH successfully negotiated a license agreement between University Medical Center Göttingen (UMG) and the biotech company Tissue Systems...

Im Focus: Silencing bacteria

HZI researchers pave the way for new agents that render hospital pathogens mute

Pathogenic bacteria are becoming resistant to common antibiotics to an ever increasing degree. One of the most difficult germs is Pseudomonas aeruginosa, a...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

“Lasers in Composites Symposium” in Aachen – from Science to Application

19.09.2017 | Event News

I-ESA 2018 – Call for Papers

12.09.2017 | Event News

EMBO at Basel Life, a new conference on current and emerging life science research

06.09.2017 | Event News

 
Latest News

Molecular Force Sensors

20.09.2017 | Life Sciences

Producing electricity during flight

20.09.2017 | Power and Electrical Engineering

Tiny lasers from a gallery of whispers

20.09.2017 | Physics and Astronomy

VideoLinks
B2B-VideoLinks
More VideoLinks >>>