Research Article
Hepatic Encephalopathy; Prevalence, Precipitating Factors and Challenges of Management in a Resource-Limited Setting
Kevin Charles Raphael1, Sarah Shali Matuja1, Nicole T Shen2, Anthony C Liwa3 and Hyasinta Jaka1*
1Department of Internal Medicine-Gastroenterology and Hepatology Unit, Catholic University of Health and Allied Sciences, Bugando, Mwanza, Tanzania
2NewYork-Presbyterian Hospital, Weill Cornell Medical Center, New York, USA
3Department of Pharmacology, Catholic University of Health and Allied Sciences, Bugando, Mwanza, Tanzania
4Discipline of Pharmaceutics, School of Pharmacy, University of the Western Cape, Bellville 7535, South Africa
- Corresponding Author:
- Hyasinta Jaka
Department of Internal Medicine-Gastroenterology and Hepatology Unit
Catholic University of Health and Allied Sciences
P.O.Box 1464, Bugando, Mwanza, Tanzania
Tel: +255-28-2500881
E-mail: yasintaliwa5@gmail.com
Received date: April 11, 2016; Accepted date: June 10, 2016; Published date: June 16, 2016
Citation: Raphael KC, Matuja SS, Shen NT, Liwa AC, Jaka H (2016) Hepatic Encephalopathy; Prevalence, Precipitating Factors and Challenges of Management in a Resource-Limited Setting. J Gastrointest Dig Syst 6:441. doi:10.4172/2161-069X.1000441
Copyright: © 2016 Raphael KC, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Abstract
Background and Aims: Hepatic encephalopathy, a neuropsychiatric syndrome caused by portosystemic venous shunting, clinical presentation ranges from minimal to overt H.E. It is a common complication of advanced liver disease with significant morbidity and mortality The aim of this study was to assess the prevalence, common precipitating factors, and outcomes of hepatic encephalopathy in patients with preexisting liver disease. Methods: A hospital based, retrospective chart review study was conducted at Bugando Medical Centre a tertiary hospital in Mwanza region. The target population included all patients aged > 18 years admitted with Hepatic encephalopathy from January 2009 to June 2015. Patients were enrolled using a detailed checklist, personal identifications were removed and analysis was done using the SPSS version 17.0. Results: A population of 88 patients with Hepatic encephalopathy were enrolled with a mean of 47 years (SD +/-17 years). Among patients admitted to the medical ward, the prevalence was 0.4% (88/23942). Most common liver disease and complications including alcoholic cirrhosis, hepatitis B infection, and hepatocellular carcinoma were present in 47.7% of (42/88), 22.7% (20/88), and 23.9% (21/88) patients, respectively. Majority had West Haven grade 3, 36.4% (32/88), and grade 4, 18.2% (16/88). Precipitating factors included diuretic therapy on patients with ascites 27.2% (44/162), infections 21.6% (35/162), blood transfusions, 16.7% (27/162), and upper gastrointestinal bleeding 17.3% (28/162). Most died during their hospitalization, 75% (66/88). The remaining 25% (22/88) were discharged. Majority of the cohort, 72.7% (64/88), had less than 3 months survival after diagnosis, while 27.3% (24/88) survived more than 1 year. Conclusions: We found severe Hepatic encephalopathy presenting in patients with preexisting liver disease associated with poor outcomes, posing challenges in management and survival. The use of newer and superior agents like polyethylene glycol, identification of subclinical Hepatic encephalopathy and targeting early removal of precipitating factors is imperative. Screening those at risk of developing Hepatic encephalopathy would likely improve outcomes.
