Diagnosis and treatment of hepatic encephalopathy in Spain: results of a survey of hepatologists

Hepatic encephalopathy is a common complication of cirrhosis. Recent studies have challenged the efficacy of nonabsorbable disaccharides and have reported that protein restriction may pose risks to patients with cirrhosis and hepatic encephalopathy. To determine the diagnostic and therapeutic practices of physicians treating patients with hepatic encephalopathy. We designed a 20-item questionnaire, which was mailed to the members of the Spanish Society for the Study of the Liver. We received 128 questionnaires, completed by physicians with wide clinical experience. They reported that the most common precipitating factors in episodic encephalopathy were infections (22%), diuretics (21%), and gastrointestinal bleeding (21%). The usual treatment of episodic encephalopathy was administration of nonabsorbable disaccharides (90%) and protein restriction (52%). Patients with chronic encephalopathy were also usually treated with nonabsorbable disaccharides (94%) and protein restriction (40%). Fifty-nine percent of the hepatologists never carried out neurophysiologic or neuropsychologic assessment for the diagnosis of minimal hepatic encephalopathy. Although their efficacy has been questioned, nonabsorbable disaccharides and protein restriction are the most commonly prescribed treatments for hepatic encephalopathy. Future studies are needed to assess the efficacy and risks of these treatments. Most hepatologists never assess minimal hepatic encephalopathy in patients with cirrhosis.