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EL IMPACTO DEL TRATAMIENTO DE LA ENCEFALOPATIA HEPATICA MINIMA EN EL PRONOSTICO A LARGO PLAZO
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Difundido en siicsalud: 13 nov 2018

EL IMPACTO DEL TRATAMIENTO DE LA ENCEFALOPATIA HEPATICA MINIMA EN EL PRONOSTICO A LARGO PLAZO

(especial para SIIC © Derechos reservados)
La encefalopatía hepática mínima (EHm) afecta del 30% al 50% de los pacientes cirróticos. Su detección es esencial por su relación con la encefalopatía hepática clínica, la alteración de la habilidad para conducir, el mayor riesgo de caídas, la alteración de la calidad de vida, la progresión más acelerada de la cirrosis y la supervivencia.      
Autor:
Manuel Romero-gomez
Columnista Experto de SIIC

Institución:
Hospital Universitario Virgen del Rocío


Artículos publicados por Manuel Romero-gomez
Coautores
Javier Ampuero* Carmen Sendra** 
Médico, Hospital Universitario Virgen del Rocío, Sevilla, España*
Médica, Hospital Universitario Virgen del Rocío, Sevilla, España**
Recepción del artículo
21 de Noviembre, 2017
Aprobación
18 de Julio, 2018
Primera edición
23 de Julio, 2018
Segunda edición, ampliada y corregida
8 de Noviembre, 2018

Resumen
La encefalopatía hepática mínima (EHm) afecta del 30% al 50% de los pacientes cirróticos. Su detección es esencial por su relación con la encefalopatía hepática clínica, la alteración de la habilidad para conducir, el mayor riesgo de caídas, la alteración de la calidad de vida, la progresión más acelerada de la cirrosis y la supervivencia. A pesar de la información fidedigna de su relevancia clínica, pronóstica y social, la detección de EHm no está generalizada en la práctica clínica. El espectro de la encefalopatía hepática engloba diversas alteraciones de las funciones cerebrales, por lo que se requiere realizar más de un test para su diagnóstico. Además, las alteraciones iniciales difieren de un paciente a otro. Esto ha dificultado el desarrollo de una estrategia diagnóstica universal. Como resultado, no disponemos de datos suficientes para generar recomendaciones basadas en la evidencia del impacto del tratamiento de la EHm en la calidad de vida y la supervivencia, así como de su rentabilidad. Por lo tanto, las guías clínicas actuales sugieren que se evalúe la EHm cuando se afecta la calidad de vida de los pacientes, ya que no se conocen las consecuencias del tamizaje. Las terapias reductoras de amonio se consideran la piedra angular del tratamiento de la EHm. Los disacáridos no absorbibles, la rifaximina y, más recientemente, los probióticos, han mostrado efectos beneficiosos. Se necesitan más ensayos controlados con placebo para evaluar la eficacia, seguridad y rentabilidad de los regímenes de tratamiento disponibles para evaluar el impacto del tratamiento de la EHm en el pronóstico a largo plazo de estos pacientes.

Palabras clave
cirrosis, lactulosa, encefalopatía hepática mínima, tests neurofisiológicos, probióticos, tests psicométricos, rifaximina


Artículo completo

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Abstract
Minimal hepatic encephalopathy (MHE) affects up to 30-50% of cirrhotic patients. The detection of MHE is essential because of its relationship with overt hepatic encephalopathy, impairment of motor vehicle driving abilities, higher risk of falls, quality of life impairment, faster cirrhosis progression and survival. Despite the robust evidence regarding its clinical, prognostic and social relevance, MHE testing is not widespread in routine clinical care. Hepatic encephalopathy spectrum covers various alterations in complex brain functions, requiring more than one test to be quantified. In addition, initial disturbances differ from one patient to another. All this has made it difficult to develop a universal diagnostic strategy. As a consequence, there is a lack of available robust data in the literature to generate evidence-based recommendations related to the impact of MHE treatment on quality of life and survival of these patients, as well as on cost-effectiveness. Therefore, current clinical guidelines suggest MHE testing only when patients have problems with their quality of life, since consequences of the screening procedure are still unclear. Ammonia lowering therapies have been considered the cornerstone of MHE treatment. Beneficial effects of non-absorbable disaccharides (lactulose or lactitol), rifaximin and more recently, probiotics have been reported. Further placebo-controlled trials are needed to assess the efficacy, safety, and cost-effectiveness of available treatment regimes to evaluate the impact of MHE treatment on the long-term prognosis of these patients.

Key words
minimal hepatic encephalopathy, cirrhosis, psychometric tests, neurophysiological tests, lactulose, rifaximin, probiotics


Clasificación en siicsalud
Artículos originales > Expertos de Iberoamérica >
página   www.siicsalud.com/des/expertocompleto.php/

Especialidades
Principal: Gastroenterología, Neurología
Relacionadas: Farmacología, Medicina Farmacéutica, Medicina Interna, Trasplantes



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Bibliografía del artículo
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