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A pilot study using lactulose in management of minimal hepatic encephalopathy in children with extrahepatic portal vein obstruction
Background Minimal hepatic encephalopathy (MHE) is not associated with overt neuropsychiatric symptoms but rather with subtle changes in psychometric and/or neurophysiologic tests. We aimed to diagnose MHE in children with extrahepatic portal vein obstruction (EHPVO) and to evaluate the effect of la...
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| Published in: | World journal of pediatrics : WJP 2017-02, Vol.13 (1), p.70-75 |
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| container_title | World journal of pediatrics : WJP |
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| creator | El-Karaksy, Hanaa Mostafa Afifi, Omneya Bakry, Azza Kader, Ann Abdel Saber, Noha |
| description | Background
Minimal hepatic encephalopathy (MHE) is not associated with overt neuropsychiatric symptoms but rather with subtle changes in psychometric and/or neurophysiologic tests. We aimed to diagnose MHE in children with extrahepatic portal vein obstruction (EHPVO) and to evaluate the effect of lactulose on MHE.
Methods
A prospective study was carried out on 30 patients with EHPVO (21 males; mean age 10±2.5 years). The study was carried out in the Pediatric Hepatology Unit, Cairo University Pediatric Hospital, Cairo, Egypt, between 2011 and 2013. All patients were subjected to clinical and laboratory assessment, neuropsychmetric testing using the arabic version of Wechsler intelligence tests, neurophysiological testing by visual electroencephalogram and P300 event related potentials (ERP).
Results
The prevalence of MHE among children with EHPVO was 20% (6/30). After randomization to treatment and no-treatment groups using lactulose, all tests were repeated after three months. Among four patients with MHE who received lactulose, three (75%) improved. On the other hand, one of the patients in the no-treatment group developed MHE. Only one patient in the treatment arm had to discontinue lactulose because of severe diarrhea.
Conclusions
This pilot study revealed that the prevalence of MHE was 20%. Improvement on psychometic tests was seen in 75% of our patients (3/4) after treatment with lactulose. Lactulose treatment was well tolerated. |
| doi_str_mv | 10.1007/s12519-016-0066-2 |
| format | article |
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Minimal hepatic encephalopathy (MHE) is not associated with overt neuropsychiatric symptoms but rather with subtle changes in psychometric and/or neurophysiologic tests. We aimed to diagnose MHE in children with extrahepatic portal vein obstruction (EHPVO) and to evaluate the effect of lactulose on MHE.
Methods
A prospective study was carried out on 30 patients with EHPVO (21 males; mean age 10±2.5 years). The study was carried out in the Pediatric Hepatology Unit, Cairo University Pediatric Hospital, Cairo, Egypt, between 2011 and 2013. All patients were subjected to clinical and laboratory assessment, neuropsychmetric testing using the arabic version of Wechsler intelligence tests, neurophysiological testing by visual electroencephalogram and P300 event related potentials (ERP).
Results
The prevalence of MHE among children with EHPVO was 20% (6/30). After randomization to treatment and no-treatment groups using lactulose, all tests were repeated after three months. Among four patients with MHE who received lactulose, three (75%) improved. On the other hand, one of the patients in the no-treatment group developed MHE. Only one patient in the treatment arm had to discontinue lactulose because of severe diarrhea.
Conclusions
This pilot study revealed that the prevalence of MHE was 20%. Improvement on psychometic tests was seen in 75% of our patients (3/4) after treatment with lactulose. Lactulose treatment was well tolerated.</description><identifier>ISSN: 1708-8569</identifier><identifier>EISSN: 1867-0687</identifier><identifier>DOI: 10.1007/s12519-016-0066-2</identifier><language>eng</language><publisher>Hangzhou: Childrens Hospital, Zhejiang University School of Medicine</publisher><subject>Critical Care Medicine ; Imaging ; Intensive ; Maternal and Child Health ; Medicine ; Medicine & Public Health ; Original Article ; Pediatric Surgery ; Pediatrics ; Radiology ; Surgery</subject><ispartof>World journal of pediatrics : WJP, 2017-02, Vol.13 (1), p.70-75</ispartof><rights>Children's Hospital, Zhejiang University School of Medicine and Springer-Verlag Berlin Heidelberg 2016</rights><rights>Copyright © Wanfang Data Co. Ltd. All Rights Reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c376t-c5b4a73c7b39fab999df95329cd020d8ad1ceb51bbe2197275478e83ed6424a03</citedby><cites>FETCH-LOGICAL-c376t-c5b4a73c7b39fab999df95329cd020d8ad1ceb51bbe2197275478e83ed6424a03</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Uhttp://www.wanfangdata.com.cn/images/PeriodicalImages/ssekzz/ssekzz.jpg</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids></links><search><creatorcontrib>El-Karaksy, Hanaa Mostafa</creatorcontrib><creatorcontrib>Afifi, Omneya</creatorcontrib><creatorcontrib>Bakry, Azza</creatorcontrib><creatorcontrib>Kader, Ann Abdel</creatorcontrib><creatorcontrib>Saber, Noha</creatorcontrib><title>A pilot study using lactulose in management of minimal hepatic encephalopathy in children with extrahepatic portal vein obstruction</title><title>World journal of pediatrics : WJP</title><addtitle>World J Pediatr</addtitle><description>Background
Minimal hepatic encephalopathy (MHE) is not associated with overt neuropsychiatric symptoms but rather with subtle changes in psychometric and/or neurophysiologic tests. We aimed to diagnose MHE in children with extrahepatic portal vein obstruction (EHPVO) and to evaluate the effect of lactulose on MHE.
Methods
A prospective study was carried out on 30 patients with EHPVO (21 males; mean age 10±2.5 years). The study was carried out in the Pediatric Hepatology Unit, Cairo University Pediatric Hospital, Cairo, Egypt, between 2011 and 2013. All patients were subjected to clinical and laboratory assessment, neuropsychmetric testing using the arabic version of Wechsler intelligence tests, neurophysiological testing by visual electroencephalogram and P300 event related potentials (ERP).
Results
The prevalence of MHE among children with EHPVO was 20% (6/30). After randomization to treatment and no-treatment groups using lactulose, all tests were repeated after three months. Among four patients with MHE who received lactulose, three (75%) improved. On the other hand, one of the patients in the no-treatment group developed MHE. Only one patient in the treatment arm had to discontinue lactulose because of severe diarrhea.
Conclusions
This pilot study revealed that the prevalence of MHE was 20%. Improvement on psychometic tests was seen in 75% of our patients (3/4) after treatment with lactulose. Lactulose treatment was well tolerated.</description><subject>Critical Care Medicine</subject><subject>Imaging</subject><subject>Intensive</subject><subject>Maternal and Child Health</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Original Article</subject><subject>Pediatric Surgery</subject><subject>Pediatrics</subject><subject>Radiology</subject><subject>Surgery</subject><issn>1708-8569</issn><issn>1867-0687</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><recordid>eNp1kD1PwzAQhiMEEqXwA9i8MQVsp7Hjsar4kiqxwGw5zqVxSe3Idijtyh_HVUFMTHcnPe-d7smya4JvCcb8LhBaEpFjwnKMGcvpSTYhFeM5ZhU_TT3HVV6VTJxnFyGsE0MJw5Psa44G07uIQhybHRqDsSvUKx3H3gVAxqKNsmoFG7ARuRZtjDUb1aMOBhWNRmA1DJ3qXRq73YHXnekbDxZtTewQfEavfuHB-ZiyH5AwV4foRx2Ns5fZWav6AFc_dZq9Pdy_Lp7y5cvj82K-zHXBWcx1Wc8ULzSvC9GqWgjRtKIsqNANpripVEM01CWpa6BEcMrLGa-gKqBhMzpTuJhmN8e9W2VbZVdy7UZv00UZArzv9xQnSwQTkkhyJLV3IXho5eDT234nCZYH3_LoWybf8uBb0pShx0xIrF2B_1v_f-gbf6yGgQ</recordid><startdate>20170201</startdate><enddate>20170201</enddate><creator>El-Karaksy, Hanaa Mostafa</creator><creator>Afifi, Omneya</creator><creator>Bakry, Azza</creator><creator>Kader, Ann Abdel</creator><creator>Saber, Noha</creator><general>Childrens Hospital, Zhejiang University School of Medicine</general><general>Department of Pediatrics, Kasr Alainy School of Medicine, Cairo University, Egypt%Department of Psychiatry, Kasr Alainy School of Medicine, Cairo University, Egypt%Department of Neurophysiology, Kasr Alainy School of Medicine, Cairo University, Egypt</general><scope>AAYXX</scope><scope>CITATION</scope><scope>2B.</scope><scope>4A8</scope><scope>92I</scope><scope>93N</scope><scope>PSX</scope><scope>TCJ</scope></search><sort><creationdate>20170201</creationdate><title>A pilot study using lactulose in management of minimal hepatic encephalopathy in children with extrahepatic portal vein obstruction</title><author>El-Karaksy, Hanaa Mostafa ; Afifi, Omneya ; Bakry, Azza ; Kader, Ann Abdel ; Saber, Noha</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c376t-c5b4a73c7b39fab999df95329cd020d8ad1ceb51bbe2197275478e83ed6424a03</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Critical Care Medicine</topic><topic>Imaging</topic><topic>Intensive</topic><topic>Maternal and Child Health</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Original Article</topic><topic>Pediatric Surgery</topic><topic>Pediatrics</topic><topic>Radiology</topic><topic>Surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>El-Karaksy, Hanaa Mostafa</creatorcontrib><creatorcontrib>Afifi, Omneya</creatorcontrib><creatorcontrib>Bakry, Azza</creatorcontrib><creatorcontrib>Kader, Ann Abdel</creatorcontrib><creatorcontrib>Saber, Noha</creatorcontrib><collection>CrossRef</collection><collection>Wanfang Data Journals - Hong Kong</collection><collection>WANFANG Data Centre</collection><collection>Wanfang Data Journals</collection><collection>万方数据期刊 - 香港版</collection><collection>China Online Journals (COJ)</collection><collection>China Online Journals (COJ)</collection><jtitle>World journal of pediatrics : WJP</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>El-Karaksy, Hanaa Mostafa</au><au>Afifi, Omneya</au><au>Bakry, Azza</au><au>Kader, Ann Abdel</au><au>Saber, Noha</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A pilot study using lactulose in management of minimal hepatic encephalopathy in children with extrahepatic portal vein obstruction</atitle><jtitle>World journal of pediatrics : WJP</jtitle><stitle>World J Pediatr</stitle><date>2017-02-01</date><risdate>2017</risdate><volume>13</volume><issue>1</issue><spage>70</spage><epage>75</epage><pages>70-75</pages><issn>1708-8569</issn><eissn>1867-0687</eissn><abstract>Background
Minimal hepatic encephalopathy (MHE) is not associated with overt neuropsychiatric symptoms but rather with subtle changes in psychometric and/or neurophysiologic tests. We aimed to diagnose MHE in children with extrahepatic portal vein obstruction (EHPVO) and to evaluate the effect of lactulose on MHE.
Methods
A prospective study was carried out on 30 patients with EHPVO (21 males; mean age 10±2.5 years). The study was carried out in the Pediatric Hepatology Unit, Cairo University Pediatric Hospital, Cairo, Egypt, between 2011 and 2013. All patients were subjected to clinical and laboratory assessment, neuropsychmetric testing using the arabic version of Wechsler intelligence tests, neurophysiological testing by visual electroencephalogram and P300 event related potentials (ERP).
Results
The prevalence of MHE among children with EHPVO was 20% (6/30). After randomization to treatment and no-treatment groups using lactulose, all tests were repeated after three months. Among four patients with MHE who received lactulose, three (75%) improved. On the other hand, one of the patients in the no-treatment group developed MHE. Only one patient in the treatment arm had to discontinue lactulose because of severe diarrhea.
Conclusions
This pilot study revealed that the prevalence of MHE was 20%. Improvement on psychometic tests was seen in 75% of our patients (3/4) after treatment with lactulose. Lactulose treatment was well tolerated.</abstract><cop>Hangzhou</cop><pub>Childrens Hospital, Zhejiang University School of Medicine</pub><doi>10.1007/s12519-016-0066-2</doi><tpages>6</tpages></addata></record> |
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| source | Springer Nature |
| subjects | Critical Care Medicine Imaging Intensive Maternal and Child Health Medicine Medicine & Public Health Original Article Pediatric Surgery Pediatrics Radiology Surgery |
| title | A pilot study using lactulose in management of minimal hepatic encephalopathy in children with extrahepatic portal vein obstruction |
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