Motor vehicle accidents: how should cirrhotic patients be managed?
Motor vehicle accidents (MVAs) are serious social issues worldwide and driver illness is an important cause of MVAs. Minimal hepatic encephalopathy (MHE) is a complex cognitive dysfunction with attention deficit, which frequently occurs in cirrhotic patients independent of severity of liver disease. Although MHE is known as a risk factor for MVAs, the impact of diagnosis and treatment of MHE on MVA-related societal costs is largely unknown. Recently, Bajaj et al demonstrated valuable findings that the diagnosis of MHE by rapid screening using the inhibitory control test (ICT), and subsequent treatment with lactulose could substantially reduce the societal costs by preventing MVAs. Besides the ICT and lactulose, there are various diagnostic tools and therapeutic strategies for MHE. In this commentary, we discussed a current issue of diagnostic tools for MHE, including neuropsychological tests. We also discussed the advantages of the other therapeutic strategies for MHE, such as intake of a regular breakfast and coffee, and supplementation with zinc and branched chain amino acids, on the MVA-related societal costs.
Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume 830-0011, Japan. takumi@med.kurume-u.ac.jp
Takumi
T
Kawaguchi
Eitaro
E
Taniguchi
Michio
M
Sata
D000063:Accidents, Traffic / Q000517:prevention & control*; D000465:Algorithms; D000597:Amino Acids, Branched-Chain / Q000627:therapeutic use; D003069:Coffee; D003071:Cognition; D003072:Cognition Disorders / Q000628:therapy; D005355:Fibrosis / Q000150:complications* / Q000628:therapy*; D006501:Hepatic Encephalopathy / Q000150:complications / Q000175:diagnosis; D006801:Humans; D007792:Lactulose / Q000627:therapeutic use; D009483:Neuropsychological Tests; D011594:Psychometrics; D012307:Risk Factors; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000517:prevention & control*; D015032:Zinc / Q000627:therapeutic use
D000597:Amino Acids, Branched-Chain; D003069:Coffee; D007792:Lactulose; D015032:Zinc