An increased ammonia level of gut bacterial origin is an important mediator in the pathogenesis of hepatic encephalopathy.
Constipation is a frequent precipitant of hepatic coma.
Diabetes mellitus may be associated with delayed gastrointestinal transit.
Dr Samuel Sigal and colleagues from New York speculated that its presence in patients with Hepatitis C-related cirrhosis would predispose to hepatic encephalopathy.
The investigative team assessed the severity of liver disease and presence of diabetes mellitus in a cross-sectional study.
The team evaluated 65 patients with Hepatitis C-related cirrhosis attending a liver transplantation clinic.
|Hepatic encephalopathy was present in 95% with diabetes|
|American Journal of Gastroenterology|
A modified Child-Pugh score that excluded hepatic encephalopathy was calculated.
The investigators assessed the frequency and severity of hepatic encephalopathy in diabetic and nondiabetic patients.
Clinical severity of cirrhosis and results of neuropsychometric testing in diabetic and nondiabetic patients with hepatic encephalopathy were compared.
The investigators found that 83% had hepatic encephalopathy.
About 30% had diabetes mellitus.
Hepatic encephalopathy was present in 95% of patients with diabetes and 78% patients without diabetes.
The team noted that hepatic encephalopathy was greater in diabetic than in nondiabetic patients.
In both the mild and severe hepatic encephalopathy categories, severity of liver disease in diabetic patients was otherwise milder than in the nondiabetic patients.
Dr Sigal's team commented, “Diabetic patients with Hepatitis C cirrhosis have more severe hepatic encephalopathy.”
“Diabetic patients have severe hepatic encephalopathy at earlier stages of biochemical decompensation and portal hypertension compared with nondiabetic patients.”