Large spontaneous portal-systemic shunts have been occasionally described in patients with cirrhosis.
Dr Oliviero Riggio and colleagues from Italy assessed the prevalence of portal-systemic shunts in patients with cirrhosis.
The research team evaluated 14 patients with recurrent or persistent hepatic encephalopathy vs 14 with cirrhosis but without hepatic encephalopathy.
The team matched patients for age and studied the degree of liver failure.
Each patient underwent neurological assessment and cerebral magnetic resonance imaging to exclude organic neurological pathological conditions.
Hepatic encephalopathy evaluation included psychometric performance, and electroencephalogram.
|Portal-systemic shunts occurred in 10 patients with hepatic encephalopathy vs 2 without|
The researchers also assessed 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.
Large spontaneous portal-systemic shunts were detected in 10 patients with hepatic encephalopathy and in only 2 patients without hepatic encephalopathy.
The researchers observed that patients with hepatic encephalopathy presented with ascites less frequently than the control group.
In addition, the team noted that patients with hepatic encephalopathy presented with medium/large esophageal varices less frequently than the control group.
Dr Riggio's team concludes, “Our study suggests that large spontaneous shunts may often sustain the chronicity of hepatic encephalopathy.”
“The presence of large shunts should be sought in patients with cirrhosis with recurrent or persistent hepatic encephalopathy.”