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Current management and future perspectives of covert hepatic encephalopathy in Japan: a nationwide survey
Takao Miwa1, Mio Tsuruoka2, Hajime Ueda3
1Department of Gastroenterology/Internal Medicine, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan. miwa.takao.a6@f.gifu-u.ac.jp.
Insights
Most Japanese physicians recognize covert hepatic encephalopathy (CHE) as a problem, but testing is limited by institutional factors and time. Simple tests and multidisciplinary teams are recommended to improve CHE management.
Area of Science:
- Hepatology
- Neurology
- Clinical Practice
Background:
- Covert hepatic encephalopathy (CHE) significantly impacts patients with cirrhosis.
- Current management and future outlook for CHE in Japan require elucidation.
Purpose of the Study:
- To investigate the real-world management of CHE in Japan.
- To identify factors influencing CHE testing and treatment implementation.
- To evaluate limitations and future perspectives for improving CHE care.
Main Methods:
- Cross-sectional questionnaire survey of physicians managing cirrhosis in Japan.
- Logistic regression analysis to identify determinants of CHE test implementation.
- Analysis of current testing methods, treatment strategies, and barriers to care.
Main Results:
- 93.9% of physicians recognized CHE as a significant problem; 62.8% performed CHE testing.
- Institutional factors and physician specialty influenced testing rates.
- Time constraints were the primary barrier for non-testers; lactulose and rifaximin were common treatments.
Conclusions:
- Physician recognition of CHE is high, but testing rates are suboptimal.
- Barriers to CHE testing include institutional factors and time constraints.
- Development of simple tests and integration of multidisciplinary teams are recommended to enhance CHE management.
Background:
Covert hepatic encephalopathy (CHE) leads to devastating outcomes in patients with cirrhosis. This study aims to elucidate the current management and future perspectives of CHE in Japan.
Methods:
A questionnaire-based cross-sectional study was conducted among physicians involved in managing cirrhosis in Japan. The primary aim was to elucidate the real-world management of CHE, including testing and treatment. Factors influencing the implementation of CHE testing were analyzed using a logistic regression model. Limitations and future perspectives for improving the management of CHE were also evaluated.
Results:
Of 511 physicians surveyed, 93.9% recognized CHE as a significant problem, and 86.9% agreed that it should be tested. Overall, 62.8% of physicians tested for CHE, whereas 37.2% did not. Multivariable analysis identified institutional factors and certifying board as significant determinants of CHE test implementation. The Stroop (68.2%) and neuropsychiatric tests (57.5%) were the most commonly used methods of identifying CHE. Among those who tested for CHE, 87.7% treated CHE; the most common treatments were lactulose (81.5%), rifaximin (76.3%), and branched-chain amino acids (70.4%). Among non-testers, the primary barrier was the time requirement for testing. Proposals to encourage CHE testing included the development of simple tests and integration of multidisciplinary teams.
Conclusions:
Most physicians involved in cirrhosis care in Japan recognize CHE as a significant problem that warrants testing. However, testing for CHE remains limited by institutional factors and physician specialties. Time requirements for CHE testing are the primary barrier, and simple tests and multidisciplinary teams are recommended to enhance CHE management.
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