Prevalence of Minimal Hepatic Encephalopathy among Chronic Hepatitis C Patients and Assessment of their Response to Lactulose

Background: Minimal hepatic encephalopathy (MHE) impairs quality of life and predicts overt hepatic encephalopathy in cirrhotic patients. Diagnosis of MHE requires cumbersome tests. Lactulose is effective in the treatment of MHE. Aim: This study aimed to detect the prevalence of (MHE) among chronic hepatitis C patients and assessment of the response of MHE patient's to treatment with lactulose after one month. Patients and Methods: One hundred and fifty six patients were evaluated by psychometry (number connection tests A, B or figure connection tests A, B), venous ammonia, and critical flicker frequency (CFF). MHE was diagnosed by abnormal psychometry (>2SD age matched controls) and abnormal CFF (CFF was considered abnormal when the value was <39 Hz). MHE patients were treated with lactulose for one month. Response was defined by normalization (<2SD of matched controls) of both psychometry and CFF (>39 Hz). Results: Of the 156 patients (age was 44.6±12.3 years, M:F was 52.8:47.2), Child Turcott Pugh groups A:B:C were 47:31:22, 116 (74.4%) had abnormal results of psychometric tests, and 111 (71.2%) had abnormal CFF. One hundred and two (65.4%) patients were diagnosed as having MHE. Child groups A:B:C among thus patients was 33:37:30. The percentage of MHE in different Child groups A, B & C was 46.6%, 79.2%& 86% respectively. After treatment for one month, 69 (67.6%) patients recovered, while 33 (32.3%) continued to have MHE. Conclusion: MHE is prevalent among patient with CHC especially among child B and C groups of patients. Lactulose is effective in the treatment of MHE.