Evaluation of Minimal Hepatic Encephalopathy in Patients With Cirrhosis and Portal Hypertension
Evaluation of Minimal Hepatic Encephalopathy in Patients With Cirrhosis and Portal Hypertension
Minimal hepatic encephalopathy (MHE) is a subclinical cognitive impairment and represents the
 mildest type of hepatic encephalopathy (HE). Portal hypertension is the main complication of
 cirrhosis and is responsible of severe complications such as HE. The consequence of portal
 hypertension is the formation of the spontaneous portosystemic shunts (SPSS). The
 relationship between the SPSS and their characteristics and the prevalence of MHE in patient
 with cirrhosis is poorly known. The main objective of this study is to evaluate the MHE in
 patients with cirrhosis and portal hypertension.
Minimal hepatic encephalopathy (MHE) is a subclinical cognitive impairment and represents the
 mildest type of hepatic encephalopathy (HE). It is a frequent complication of the liver
 disease, affecting up to 80% of tested patients. MHE affects severely the lives of patients
 by altering their quality-of-life and their socioeconomic status and is strongly associated
 to the development of overt HE. Portal hypertension is the main complication of cirrhosis and
 is responsible of severe complications such as HE. The consequence of portal hypertension is
 the formation of the spontaneous portosystemic shunts (SPSS). Their presence has been
 associated with recurrent or persistent HE. The relationship between the SPSS and their
 characteristics and the prevalence of MHE in patient with cirrhosis is poorly known.

 Patients with compensated cirrhosis and portal hypertension will be considered for inclusion.
 After written inform consent, the serum ammonia, psychometric hepatic encephalopathy score
 (PHES) and the animal naming test (ANT) will be performed to evaluate the presence of MHE.
 Patients diagnosed with MHE will be treated and a new evaluation will be performed 6 months
 later.
Inclusion Criteria:

 -  Patient with cirrhosis and portal hypertension older than 18 old

 -  Patient who underwent a CT scan or MRI in the last 3 months

 -  The Mini-Mental State (MMS) test >25.

 -  Patient capable of receiving and understanding information relating to the study and
 of giving his written informed consent.

 -  Patient affiliated to the French social security system

 Exclusion Criteria:

 -  Cirrhotic patient with overt HE or history of persistent or recurrent HE.

 -  Hepatocellular carcinoma beyond Milan criteria.

 -  Portal vein thrombosis.

 -  Previous transjugular intrahepatic portosystemic shunt (TIPS) or surgical shunt.

 -  Presence of neurological or psychiatric disorder.

 -  Patient with treatment by benzodiazepines or opioid substitution.

 -  Pregnant or nursing women

 -  Patient in exclusion period of a previous study

 -  Patient under guardianship, trusteeship or the protection of justice or incapable of
 giving their own informed consent