Sharma Praveen, Sharma Barjesh C
Department of Gastroenterology and Hepatology, Sir Ganga Ram Hospital, New Delhi, India.
Saudi J Gastroenterol. 2014 Sep-Oct;20(5):304-8. doi: 10.4103/1319-3767.141692.
BACKGROUND/AIM: Minimal hepatic encephalopathy (MHE) leads to overt hepatic encephalopathy (HE) and impairs quality of life in patients with cirrhosis. Awareness of MHE and its management among physicians is not known.
We conducted a survey among 673 physicians in India from academic and nonacademic institutes to understand the clinical burden, perceived severity, management patterns, and the barriers to providing care for this condition.
Overall awareness of MHE in this survey was 75% (n = 504). Awareness of MHE was significantly higher in physicians working in teaching hospitals compared with those in nonteaching hospitals (79% vs 71%, P = 0.02). Similarly, gastroenterologists were more aware of MHE compared with nongastroenterologists (91% vs 66%, P = 0.001). Only 6.3% physicians screened all of their patients for MHE, whereas frequency of testing for MHE, either being nil or less than 10% of their patients was 64.7%. The most common test was paper and pencil test (86%) and the reason for nonscreening was nonavailability of time to test and also equipment or method (81%). A majority of physicians (88%) think that MHE affects quality of life. Physicians (61%) had an opinion that there should be some registry of MHE regardless of the cost and effort involved. Lactulose was used in 93% of cases, followed by rifaximin (82%) in the management of MHE.
The overall awareness of MHE was 75% and it was significantly more in physicians of academic institutes. Despite awareness of its effect on quality of life, a majority of physicians did not test for MHE in their day-to-day practice.
背景/目的：轻微肝性脑病（MHE）可发展为显性肝性脑病（HE），并损害肝硬化患者的生活质量。目前尚不清楚医生对MHE及其管理的认知情况。
我们对印度673名来自学术机构和非学术机构的医生进行了一项调查，以了解MHE的临床负担、感知严重程度、管理模式以及提供该疾病护理的障碍。
本次调查中，医生对MHE的总体认知率为75%（n = 504）。与非教学医院的医生相比，教学医院的医生对MHE的认知率显著更高（79%对71%，P = 0.02）。同样，与非胃肠病学家相比，胃肠病学家对MHE的认知更多（91%对66%，P = 0.001）。只有6.3%的医生对所有患者进行MHE筛查，而MHE检测频率为零或低于其患者10%的比例为64.7%。最常用的检测方法是纸笔测试（86%），未进行筛查的原因是没有时间进行检测以及缺乏设备或方法（81%）。大多数医生（88%）认为MHE会影响生活质量。61%的医生认为无论成本和工作量如何，都应该建立MHE登记册。在MHE的管理中，93%的病例使用了乳果糖，其次是利福昔明（82%）。
医生对MHE的总体认知率为75%，学术机构的医生认知率显著更高。尽管认识到其对生活质量的影响，但大多数医生在日常实践中并未对MHE进行检测。
