studies

HEPATOLOGY, VOLUME 62, NUMBER 1 (SUPPL) AASLD ABSTRACTS 929A
were significant. On multi-variate analysis, recent alcohol (OR
4.0, p=0.003) and illegal turns (OR 1.4, p=0.005) remained
significant predictors of real-life crashes. Conclusion: In this
largest-studied cirrhosis cohort, MHE subjects were likely to
have worse simulator and real-life crash rates that remains
stable over 1 year. Only MHE patients who performed poorly
on navigation and had quit alcohol within 3 years were likely
to be unsafe drivers.
Summarized of results
Table shows summarized of results from driving simulation, real
life traffic history and 6-month follow up in 163 patients.
Disclosures:
Richard K. Sterling - Advisory Committees or Review Panels: Merck, Vertex, Salix,
Bayer, BMS, Abbott, Gilead, Baxter, Jansen; Grant/Research Support: Merck,
Roche/Genentech, Pfizer, Gilead, Boehringer Ingelheim, Bayer, BMS, Abbott
Puneet Puri - Advisory Committees or Review Panels: Health Diagnostic Laboratory
Inc.; Consulting: NPS Pharmaceuticals Inc.
Arun J. Sanyal - Advisory Committees or Review Panels: Bristol Myers, Gilead,
Genfit, Abbott, Ikaria, Exhalenz; Consulting: Salix, Immuron, Exhalenz, Nimbus,
Genentech, Echosens, Takeda, Merck, Enanta, Zafgen, JD Pharma, Islet
Sciences; Grant/Research Support: Salix, Genentech, Intercept, Ikaria, Takeda,
GalMed, Novartis, Gilead, Tobira; Independent Contractor: UpToDate, Elsevier
Douglas M. Heuman - Consulting: Bayer, Grifols, Genzyme; Grant/Research
Support: Exilixis, Novartis, Bayer, Bristol Myers Squibb, Scynexis, Ocera, Mannkind,
Salix, Globeimmune, Roche, SciClone, Wyeth, Otsuka, Ikaria, UCB, Celgene,
Centocor, Millenium, Osiris, AbbVie, Gilead; Speaking and Teaching:
Otsuka, Astellas
Jasmohan S. Bajaj - Advisory Committees or Review Panels: Salix, Merz, otsuka,
ocera, grifols, american college of gastroenterology; Grant/Research Support:
salix, otsuka, grifols
The following authors have nothing to disclose: Mette M. Lauridsen, Vishwadeep
Ahluwalia, Ariel Unser, Melanie White, R. Todd Stravitz, Scott C. Matherly,
Velimir A. Luketic, Mohammad S. Siddiqui, Michael Fuchs
1473
Randomized Controlled Trial on Efficacy of Nutritional
Therapy on Cognitive Functions and Health Related
Quality of Life in Patients of Liver Cirrhosis with Minimal
Hepatic Encephalopathy
Sudhir Maharshi, Barjesh C. Sharma, Sanjeev Sachdeva, Siddharth
Srivastava; Gastroenterology, G B Pant Institute of Post
graduate Medical Education and Research, New delhi, India
Background & Aims: Minimal hepatic encephalopathy impairs
health related quality of life (HRQOL), predicts development of
overt hepatic encephalopathy and associated with poor prognosis.
There is no study on nutritional management in patients
with minimal hepatic encephalopathy. We assessed the effects
of nutritional therapy on cognitive functions and HRQOL in
patients of cirrhosis with minimal hepatic encephalopathy.
Methods: A randomized controlled trial conducted in a tertiary
care setting on patients of cirrhosis with minimal hepatic
encephalopathy who were randomized to nutritional therapy
(group A: 30-35 kcal/kg/day and 1 . 0-1 . 5 gram of vegetable
protein/kg/day) and no nutritional therapy (group B: diet as
patients were taking before) for 6 months. Minimal hepatic
encephalopathy was diagnosed based on psychometry hepatic
encephalopathy score (PHES). HRQOL was assessed by sickness
impact profile (SIP) questionnaire. Primary endpoints were
improvement or worsening in minimal hepatic encephalopathy
and improvement in HRQOL. Results: 120 patients were
randomized to group-A (n = 60, age 42 . 1±10 . 3 yr, 48 men)
and group-B (n = 60, age 42 . 4±9 . 6 yr, 47 men). There was
no significant difference in baseline characteristics between
the two groups. Baseline PHES (-8 . 12±1 . 32 vs -8 . 53±1 . 38;
p=0 . 08) and SIP score (14 . 25±5.8 vs 15 . 44±5 . 03; p=0 . 85)
were comparable in both the groups. Reversal of minimal
hepatic encephalopathy was higher in group A (71 . 1% vs
22 . 8%; p=0 . 001). Improvement in PHES (ΔPHES 3 . 86±3 . 58
vs 0 . 52±4 . 09; p=0 . 001) and HRQOL (Δ SIP 3 . 24±3 . 63 vs
0 . 54±3 . 58; p=0 . 001) were also higher in group A compared
to group B. Overt hepatic encephalopathy developed in 10%
of patients in group A vs 21 . 7% in group B (P=0 . 04). Conclusions:
Nutritional therapy is effective in treatment of minimal
hepatic encephalopathy and associated with improvement in
HRQOL.
Disclosures:
The following authors have nothing to disclose: Sudhir Maharshi, Barjesh C.
Sharma, Sanjeev Sachdeva, Siddharth Srivastava
1474
Usefulness of Balloon-Occluded Retrograde Obliteration
(B-RTO) as a Therapeutic Procedure to Improve Liver
Function in Cirrhotic Patients with Porto-Systemic Shunts
Manabu Nakazawa, Yukinori Imai, Satsuki Ando, Kayoko Sugawara,
Mie Inao, Nobuaki Nakayama, Satoshi Mochida; Gastroenterology
& Hepatology, Saitama medical university hospital,
Saitama, Japan
Aim: Porto-systemic shunts cause refractory hepatic encephalopathy
in patients with liver cirrhosis. The shunts also contribute
to derange liver function through reduction of blood flow in
the portal vein. The usefulness of B-RTO as a therapeutic procedure
for improvement of liver function as well as attenuation of
refractory hepatic encephalopathy was evaluated in cirrhotic
patients. Methods: The subjects were 34 cirrhotic patients with
porto-systemic shunts showing refractory hepatic encephalopathy.
The extent of liver dysfunction classified according to the
Child-Pugh classification were grade A, B and C in 3, 18 and
13 patients, respectively. A balloon catheter was inserted into
the shunts followed by injection of 5% ethanolamine oleate
through the catheter under balloon inflation. The balloon was
kept inflation for between 6 and 48 hours depending on
sizes of the shunts. Results: Drainage vessels of the targeted
shunts were the splenorenal, mesocaval, paraumbilical, azygos
and splenorenal plus azygos veins in 20, 4, 6, 2 and
2 patients, respectively. B-RTO was successfully done in 29
patients (85%), and hepatic encephalopathy did not recur in
24 (83%) patients. In patients receiving successful B-RTO procedures,
HH15, LHL15 and LU15 values assessed by Tc-99m
GSA scintigraphy were not different between at baseline and
1 months after the procedures, while doppler ultrasound examinations
revealed that blood flows in the portal vein (cm 3 /sec;
mean±SD) increased significantly (from 2.2±0.9 to 8.4±2.4,
p