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Measure for small measures

Minimal hepatic encephalopathy (MHE) represents the mildest form of hepatic encephalopathy and the diagnostic criteria for MHE were formally standardised in 2002 (

) . Although patients with MHE may not have overt symptoms and signs, MHE impairs health-related quality of life (HRQoL), activities of daily life (including ability to drive) and predicts development of overt encephalopathy.

Prasad et al measured psychometric performance by number and finger connection tests, picture completion and block design tests in 90 patients with cirrhosis to identify 61 (68%) patients with MHE. These 61 patients were randomised in a non-blinded study design to receive lactulose (30–60 ml in two to three doses so that patients passed two to three semisolid stools per day) for 3 months (n = 31) or no treatment (n = 30). Mean number of abnormal neuropsychological tests decreased significantly from 2.74 (95% CI 2.4 to 3.1) at baseline to 0.75 (95% CI 0.4 to1.2) in the treated group (p = 0.001). HRQoL as measured by Sickness Impact Profile improved among treated patients from a mean baseline score of 10.39 (95% CI 9.4 to11.4) to 3.77 (95% CI 2.5 …

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