title: High prevalence of spontaneous portal-systemic shunts in persistent hepatic encephalopathy: a case-control study.
abstract: Large spontaneous portal-systemic shunts have been occasionally described in patients with cirrhosis. This study was undertaken to assess the prevalence of portal-systemic shunts in patients with cirrhosis with recurrent or persistent hepatic encephalopathy (HE) as compared with patients with cirrhosis without HE. Fourteen patients with cirrhosis with recurrent or persistent HE (cases) and 14 patients with cirrhosis without previous or present signs of overt HE matching for age and degree of liver failure (controls) were studied. Each patient underwent neurological assessment and cerebral magnetic resonance (MR) imaging to exclude organic neurological pathological conditions. HE evaluation included psychometric performance (Trail-Making Test A), electroencephalogram (EEG), mental status examination and grading, arterial, venous, and partial pressure of ammonia determination. The presence of portal-systemic shunts was assessed by portal venous phase multidetector-row spiral computed tomography (CT). Large spontaneous portal-systemic shunts were detected in 10 patients with HE and in only 2 patients without HE (71% vs. 14%; chi square = 9.16; df = 1.0; P = .002). The patients with HE presented ascites (P = .002) and medium/large esophageal varices (P = .02) less frequently than the control group. In conclusion, our study suggests that large spontaneous shunts may often sustain the chronicity of HE; the presence of large shunts should be sought in patients with cirrhosis with recurrent or persistent HE.
authors.affiliation: Department of Clinical Medicine, Division of Gastroenterology; University of Rome La Sapienza, Rome, Italy. oliviero.riggio@uniroma1.it
authors.forename: Oliviero
authors.initials: O
authors.lastname: Riggio
authors.forename: Cesare
authors.initials: C
authors.lastname: Efrati
authors.forename: Carlo
authors.initials: C
authors.lastname: Catalano
authors.forename: Federica
authors.initials: F
authors.lastname: Pediconi
authors.forename: Oriano
authors.initials: O
authors.lastname: Mecarelli
authors.forename: Neri
authors.initials: N
authors.lastname: Accornero
authors.forename: Francesca
authors.initials: F
authors.lastname: Nicolao
authors.forename: Stefania
authors.initials: S
authors.lastname: Angeloni
authors.forename: Andrea
authors.initials: A
authors.lastname: Masini
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Ridola
authors.forename: Adolfo F
authors.initials: AF
authors.lastname: Attili
authors.forename: Manuela
authors.initials: M
authors.lastname: Merli
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D004569:Electroencephalography; D004932:Esophageal and Gastric Varices / Q000209:etiology; D005260:Female; D006501:Hepatic Encephalopathy / Q000150:complications* / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D021621:Imaging, Three-Dimensional; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D011168:Portal System / Q000503:physiopathology*; D011169:Portal Vein / Q000000981:diagnostic imaging; D012008:Recurrence; D036542:Tomography, Spiral Computed