Skip to main content

Advertisement

SpringerLink
Log in

Prevalence of hepatic encephalopathy in patients with non-cirrhotic portal hypertension: A systematic review and meta-analysis

  • SYSTEMATIC REVIEW and META-ANALYSIS
  • Published:
Indian Journal of Gastroenterology Aims and scope Submit manuscript

Abstract

Background

Hepatic encephalopathy, (HE) although commonly associated with cirrhosis, has also been reported in non-cirrhotic portal hypertension (NCPH). The importance of identifying and treating HE in NCPH lies in the fact that many patients may be wrongly diagnosed as having psychiatric or neurologic disorders. Hence, we aimed to systematically review the prevalence of HE in NCPH.

Methods

A comprehensive search of three databases (Medline, Embase and Scopus) was conducted from inception to November 2022 for studies reporting on the prevalence of minimal HE (MHE) and overt HE (OHE) in patients with NCPH. Results were presented as pooled proportions with their 95% confidence intervals (CI).

Results

Total 25 studies (n = 1487) were included after screening 551 records. The pooled prevalence of MHE in NPCH was 32.9% (95% CI: 26.7–39.0) without any difference between adult (32.9%, 95% CI: 23.5–42.3) and pediatric patients (32.6%, 95% CI: 26.1–39.1) (p = 0.941). There was no significant difference in the prevalence between patients with NCPH and compensated cirrhosis with odds ratio of 1.06 (95% CI: 0.77–1.44). The pooled event rate for prior history of OHE in NCPH was 1.2% (95% CI: 0.3–2.1).

Conclusion

Around one-third of the patients with NCPH have MHE, irrespective of age group. OHE is extremely rare in NCPH and is usually associated with a precipitating factor.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Louissaint J, Deutsch-Link S, Tapper EB. Changing epidemiology of cirrhosis and hepatic encephalopathy. Clin Gastroenterol Hepatol. 2022;20:S1-8.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Gioia S, Nardelli S, Ridola L, Riggio O. Causes and management of non-cirrhotic portal hypertension. Curr Gastroenterol Rep. 2020;22:1–8.

    Article  Google Scholar 

  3. Gioia S, Nardelli S, Riggio O, Faccioli J, Ridola L. Cognitive impairement in non-cirrhotic portal hypertension: highlights on physiopathology, diagnosis and management. J Clin Med. 2021;11:101.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Lima LC, Miranda AS, Ferreira RN, Rachid MA, e Silva AC. Hepatic encephalopathy: lessons from preclinical studies. World J Hepatol. 2019;11:173–85.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Yadav SK, Srivastava A, Srivastava A, et al. Encephalopathy assessment in children with extra-hepatic portal vein obstruction with MR, psychometry and critical flicker frequency. J Hepatol. 2010;52:348–54.

    Article  PubMed  Google Scholar 

  6. Watanabe A. Portal-systemic encephalopathy in non-cirrhotic patients: classification of clinical types, diagnosis and treatment. J Gastroenterol Hepatol. 2000;15:969–79.

    Article  CAS  PubMed  Google Scholar 

  7. Dhiman RK, Chawla Y, Vasishta RK et al. Non-cirrhotic portal fibrosis (idiopathic portal hypertension): experience with 151 patients and a review of the literature. J Gastroenterol Hepatol. 2002;17:6–16.

    Article  PubMed  Google Scholar 

  8. Peter L, Dadhich SK, Yachha SK. Clinical and laboratory differentiation of cirrhosis and extrahepatic portal venous obstruction in children. J Gastroenterol Hepatol. 2003;18:185–9.

    Article  PubMed  Google Scholar 

  9. Mínguez B, García-Pagán JC, Bosch J, et al. Noncirrhotic portal vein thrombosis exhibits neuropsychological and MR changes consistent with minimal hepatic encephalopathy. Hepatology. 2006;43:707–14.

    Article  PubMed  Google Scholar 

  10. Das K, Singh P, Chawla Y, Duseja A, Dhiman RK, Suri S. Magnetic resonance imaging of brain in patients with cirrhotic and non-cirrhotic portal hypertension. Dig Dis Sci. 2008;53:2793–8.

    Article  PubMed  Google Scholar 

  11. Sharma P, Sharma BC, Puri V, Sarin SK. Minimal hepatic encephalopathy in patients with extrahepatic portal vein obstruction. Am J Gastroenterol. 2008;103:1406–12.

    Article  PubMed  Google Scholar 

  12. Goel A, Yadav S, Saraswat V, et al. Cerebral oedema in minimal hepatic encephalopathy due to extrahepatic portal venous obstruction. Liver Int. 2010;30:1143–51.

    Article  CAS  PubMed  Google Scholar 

  13. Pasquale C, Ridola L, Pentassuglio I, et al. Type-B (BYPASS) minimal hepatic encephalopathy (MHE) in patients with non-cirrhotic portal hypertension: relationship with the quality of life (QOL). Hepatology. 2010;52:901A-902A.

    Google Scholar 

  14. Srivastava A, Yadav SK, Lal R, et al. Effect of surgical portosystemic shunt on prevalence of minimal hepatic encephalopathy in children with extrahepatic portal venous obstruction: assessment by magnetic resonance imaging and psychometry. J Pediatr Gastroenterol Nutr. 2010;51:766–72.

    Article  PubMed  Google Scholar 

  15. Yadav SK, Saksena S, Srivastava A, et al. Brain MR imaging and 1H-MR spectroscopy changes in patients with extrahepatic portal vein obstruction from early childhood to adulthood. AJNR Am J Neuroradiol. 2010;31:1337–42.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Srivastava A, Yadav SK, Yachha SK, Thomas MA, Saraswat VA, Gupta RK. Pro-inflammatory cytokines are raised in extrahepatic portal venous obstruction, with minimal hepatic encephalopathy. J Gastroenterol Hepatol. 2011;26:979–86.

    Article  CAS  PubMed  Google Scholar 

  17. Schouten JN, Nevens F, Hansen B, et al. Idiopathic noncirrhotic portal hypertension is associated with poor survival: results of a long-term cohort study. Aliment Pharmacol Ther. 2012;35:1424–33.

    Article  CAS  PubMed  Google Scholar 

  18. Sharma P, Sharma BC. Lactulose for minimal hepatic encephalopathy in patients with extrahepatic portal vein obstruction. Saudi J Gastroenterol. 2012;18:168–72.

    Article  PubMed  PubMed Central  Google Scholar 

  19. D’Antiga L, Dacchille P, Boniver C, et al. Clues for minimal hepatic encephalopathy in children with noncirrhotic portal hypertension. J Pediatr Gastroenterol Nutr. 2014;59:689–94.

    Article  PubMed  Google Scholar 

  20. Siramolpiwat S, Seijo S, Miquel R, et al. Idiopathic portal hypertension: natural history and long-term outcome. Hepatology. 2014;59:2276–85.

    Article  PubMed  Google Scholar 

  21. Yogesh KR, Ali M, Pugazhendi T, et al. Minimal hepatic encephalopathy in children withextrahepatic portal vein obstruction. Indian J Gastroenterol. 2014;33:A54.

    Google Scholar 

  22. Babar G, Thomas V. Occurrence of minimal hepatic encephalopathy in patients of extrahepatic portal hypertensionversus cirrhosis of the liver (Child A) – a comparative study. Indian J Gastroenterol. 2015;34:A32.

    Google Scholar 

  23. Nicoletti V, Gioia S, Lucatelli P, et al. Hepatic encephalopathy in patients with non-cirrhotic portal hypertension: description, prevalence and risk factors. Dig Liver Dis. 2016;48:1072–7.

    Article  PubMed  Google Scholar 

  24. Yadav SK, Goel A, Saraswat VA, et al. Evaluation of cognitivity, proinflammatory cytokines, and brain magnetic resonance imaging in minimal hepatic encephalopathy induced by cirrhosis and extrahepatic portal vein obstruction. J Gastroenterol Hepatol. 2016;31:1986–94.

    Article  CAS  PubMed  Google Scholar 

  25. El-Karaksy HM, Afifi O, Bakry A, Kader AA, Saber N. A pilot study using lactulose in management of minimal hepatic encephalopathy in children with extrahepatic portal vein obstruction. World J Pediatr. 2017;13:70–5.

    Article  CAS  PubMed  Google Scholar 

  26. Suresh MV, Jagadisan B, Kandasamy P, Senthilkumar GP. Stroop test validation to screen for minimal hepatic encephalopathy in pediatric extrahepatic portal venous obstruction. J Pediatr Gastroenterol Nutr. 2018;66:802–7.

    Article  PubMed  Google Scholar 

  27. Liu M, He WT, Chen DS, Hu DH. Analysis of influencing factors on hepatic encephalopathy in patients with non-cirrhotic portal hypertension. Zhonghua Gan Zang Bing Za Zhi. 2019;27:673–6.

    CAS  PubMed  Google Scholar 

  28. Lv Y, Li K, He C, et al. TIPSS for variceal bleeding in patients with idiopathic non-cirrhotic portal hypertension: comparison with patients who have cirrhosis. Aliment Pharmacol Ther. 2019;49:926–39.

    Article  PubMed  Google Scholar 

  29. Elkrief L, Lazareth M, Chevret S, et al. Liver stiffness by transient elastography to detect porto-sinusoidal vascular liver disease with portal hypertension. Hepatology. 2021;74:364–78.

    Article  PubMed  Google Scholar 

  30. Wöran K, Semmler G, Jachs M, et al. Clinical course of porto-sinusoidal vascular disease is distinct from idiopathic noncirrhotic portal hypertension. Clin Gastroenterol Hepatol. 2022;20:e251–66.

    Article  PubMed  Google Scholar 

  31. Ferenci P, Lockwood A, Mullen K, Tarter R, Weissenborn K, Blei AT. Hepatic encephalopathy–definition, nomenclature, diagnosis, and quantification: final report of the working party at the 11th World Congresses of Gastroenterology, Vienna, 1998. Hepatology. 2002;35:716–21.

    Article  PubMed  Google Scholar 

  32. Sharma P, Sharma BC, Puri V, Sarin SK. Natural history of minimal hepatic encephalopathy in patients with extrahepatic portal vein obstruction. Am J Gastroenterol. 2009;104:885–90.

    Article  PubMed  Google Scholar 

  33. Groeneweg M, Quero JC, De Bruijn I, et al. Subclinical hepatic encephalopathy impairs daily functioning. Hepatology. 1998;28:45–9.

  34. Bao ZJ, Qiu DK, Ma X, et al. Assessment of health-related quality of life in Chinese patients with minimal hepatic encephalopathy. World J Gastroenterol. 2007;13:3003–8.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Krishna YR, Yachha SK, Srivastava A, Negi D, Lal R, Poddar U. Quality of life in children managed for extrahepatic portal venous obstruction. J Pediatr Gastroenterol Nutr. 2010;50:531–6.

    Article  PubMed  Google Scholar 

  36. D’Antiga L, Casotti V, Caffi LG, et al. The conundrum of cognitive dysfunction in children with portal hypertension: the experience of Bergamo. Italy J Clin Exp Hepatol. 2022;12:723–4.

    Article  PubMed  Google Scholar 

  37. Bajaj JS, Saeian K, Christensen KM, et al. Probiotic yogurt for the treatment of minimal hepatic encephalopathy. Am J Gastroenterol. 2008;103:1707–15.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Gastroenterology, Nizam’s Institute of Medical Sciences, Hyderabad, 500 082, India

    Suprabhat Giri & Sumaswi Angadi

  2. Department of Gastroenterology, Seth G S Medical College and K E M Hospital, Mumbai, 400 012, India

    Ankita Singh

  3. Department of Gastroenterology, Narayana Hospital, Nanded, 431 602, India

    Kailash Kolhe

  4. Institute of Gastrosciences and Liver Transplantation, Apollo Multispecialty Hospital, Kolkata, 700 054, India

    Akash Roy

Authors
  1. Suprabhat Giri
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ankita Singh
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sumaswi Angadi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kailash Kolhe
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Akash Roy
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Conceptualization: SG, AS; data curation: SG, SG, SA; formal analysis: SG, AS, SA; funding acquisition: N/A; investigation: SG, AS, SA, KK; methodology: SG, SA; project administration: SG, AR; resources: SG, AS, SA; software: SG; supervision: SG, KK; validation: SG, AR; visualization: SG; roles/writing — original draft: SG, AS, SA; writing — review and editing: SG, AS, SA, KK, AR.

Corresponding author

Correspondence to Akash Roy.

Ethics declarations

Ethical approval

Not required.

Conflict of interest

 SG, AS, SA, KK and AR declare no competing interests.

Disclaimer

The authors are solely responsible for the data and the contents of the paper. In no way, the Honorary Editor-in-Chief, Editorial Board Members, the Indian Society of Gastroenterology or the printer/publishers are responsible for the results/findings and content of this article.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 681 KB)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Giri, S., Singh, A., Angadi, S. et al. Prevalence of hepatic encephalopathy in patients with non-cirrhotic portal hypertension: A systematic review and meta-analysis. Indian J Gastroenterol 42, 642–650 (2023). https://doi.org/10.1007/s12664-023-01412-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12664-023-01412-1

Keywords

Search

Navigation