Neurologic Manifestations of Hepatic and Gastrointestinal Disease

This article discusses the pathophysiology, diagnosis, and management of neurologic complications of hepatic and gastrointestinal diseases.

Hepatic and gastrointestinal diseases such as hepatitis C, Wilson disease, inflammatory bowel disease, and celiac disease can initially present with neurologic symptoms, and neurologic syndromes may be the only manifestations of these conditions. Renal replacement therapy to decrease ammonia levels reduces mortality in patients with acute hepatic encephalopathy. Patients with chronic liver disease should be screened for covert cognitive changes to facilitate earlier initiation of ammonia-lowering therapies to decrease episodes of overt hepatic encephalopathy.

Hepatic encephalopathy has different clinical presentations and management depending on whether it is due to acute or chronic liver disease. Rare complications of chronic liver disease include hepatic myelopathy and acquired hepatocellular degeneration. Gastrointestinal disorders and bariatric surgery can cause malabsorption, leading to vitamin and mineral deficiencies that can present as neurologic disorders such as neuropathy, myelopathy, and neuropsychiatric symptoms. Celiac disease can cause neurologic symptoms such as ataxia without associated gastrointestinal symptoms and should therefore be considered in the differential diagnosis of ataxia. Inflammatory bowel disease increases the risk of thrombotic events, and treatment of inflammatory bowel disease with tumor necrosis factor-α inhibitor therapy can cause central and peripheral nervous system inflammatory complications.