Diabetes mellitus is associated with hepatic encephalopathy in patients with HCV cirrhosis

Samuel H. Sigal, Carmen M. Stanca, Nickolas Kontorinis, Carol Bodian, Elizabeth Ryan

Research output: Contribution to journalArticle

52 Citations (Scopus)

Abstract

OBJECTIVES: An increased ammonia level of gut bacterial origin is an important mediator in the pathogenesis of hepatic encephalopathy (HE), and constipation is a frequent precipitant of hepatic coma. Because diabetes mellitus (DM) may be associated with delayed gastrointestinal transit, we speculated that its presence in patients with HCV-related cirrhosis would predispose to and exacerbate HE. METHODS: Sixty-five patients (50 men, 15 women) with HCV-related cirrhosis attending a liver transplantation clinic were assessed for severity of liver disease and presence of DM in a cross-sectional study. A modified Child-Pugh score that excluded HE was calculated. Frequency and severity of HE (absent, mild, and severe) in diabetic and nondiabetic patients were assessed. Clinical severity of cirrhosis and results of neuropsychometric testing in diabetic and nondiabetic patients with mild and severe HE were compared. RESULTS: Fifty-four patients (83%) had HE (33 mild, 21 severe). Twenty patients (31%) had DM. HE was present in 19 (95%) patients with diabetes and 35 (78%) patients without diabetes (p = 0.087). Severity of HE was greater in diabetic (35% mild, 60% severe) than in nondiabetic patients (58% mild, 20% severe) (p = 0.007). In both the mild and severe HE categories, severity of liver disease in diabetic patients was otherwise milder than in the nondiabetic patients. CONCLUSIONS: Diabetic patients with HCV cirrhosis have more severe HE. Diabetic patients have severe HE at earlier stages of biochemical decompensation and portal hypertension compared with nondiabetic patients.

Original languageEnglish (US)
Pages (from-to)1490-1496
Number of pages7
JournalAmerican Journal of Gastroenterology
Volume101
Issue number7
DOIs
StatePublished - Jul 2006
Externally publishedYes

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Hepatic Encephalopathy
Diabetes Mellitus
Fibrosis
Liver Diseases
Gastrointestinal Transit
Portal Hypertension
Constipation
Ammonia
Liver Transplantation

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Diabetes mellitus is associated with hepatic encephalopathy in patients with HCV cirrhosis. / Sigal, Samuel H.; Stanca, Carmen M.; Kontorinis, Nickolas; Bodian, Carol; Ryan, Elizabeth.

In: American Journal of Gastroenterology, Vol. 101, No. 7, 07.2006, p. 1490-1496.

Research output: Contribution to journalArticle

Sigal, Samuel H. ; Stanca, Carmen M. ; Kontorinis, Nickolas ; Bodian, Carol ; Ryan, Elizabeth. / Diabetes mellitus is associated with hepatic encephalopathy in patients with HCV cirrhosis. In: American Journal of Gastroenterology. 2006 ; Vol. 101, No. 7. pp. 1490-1496.
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abstract = "OBJECTIVES: An increased ammonia level of gut bacterial origin is an important mediator in the pathogenesis of hepatic encephalopathy (HE), and constipation is a frequent precipitant of hepatic coma. Because diabetes mellitus (DM) may be associated with delayed gastrointestinal transit, we speculated that its presence in patients with HCV-related cirrhosis would predispose to and exacerbate HE. METHODS: Sixty-five patients (50 men, 15 women) with HCV-related cirrhosis attending a liver transplantation clinic were assessed for severity of liver disease and presence of DM in a cross-sectional study. A modified Child-Pugh score that excluded HE was calculated. Frequency and severity of HE (absent, mild, and severe) in diabetic and nondiabetic patients were assessed. Clinical severity of cirrhosis and results of neuropsychometric testing in diabetic and nondiabetic patients with mild and severe HE were compared. RESULTS: Fifty-four patients (83{\%}) had HE (33 mild, 21 severe). Twenty patients (31{\%}) had DM. HE was present in 19 (95{\%}) patients with diabetes and 35 (78{\%}) patients without diabetes (p = 0.087). Severity of HE was greater in diabetic (35{\%} mild, 60{\%} severe) than in nondiabetic patients (58{\%} mild, 20{\%} severe) (p = 0.007). In both the mild and severe HE categories, severity of liver disease in diabetic patients was otherwise milder than in the nondiabetic patients. CONCLUSIONS: Diabetic patients with HCV cirrhosis have more severe HE. Diabetic patients have severe HE at earlier stages of biochemical decompensation and portal hypertension compared with nondiabetic patients.",
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