Epidemiology

Minimal hepatic encephalopathy associated with increased traffic accidents

Last Updated: 2007-10-02 16:20:51 -0400 (Reuters Health)

By Will Boggs, MD

NEW YORK (Reuters Health) - Patients with minimal hepatic encephalopathy (MHE) report more traffic accidents and violations than other individuals, according to a report in the September issue of the American Journal of Gastroenterology.

"I would hope for physicians who take care of patients with cirrhosis to be open about this hidden epidemic of MHE which can threaten both the patient and other drivers they interact with on the road," Dr. Jasmohan S. Bajaj from Medical College of Wisconsin, Milwaukee, told Reuters Health. "Patients with cirrhosis who are not actively drinking should always be asked about their driving history."

Dr. Bajaj and colleagues investigated the occurrence of traffic violations and motor vehicle accidents using an anonymous questionnaire survey sent to 200 cirrhotic patients with or without MHE and 100 population controls.

Significantly more cirrhotics (18%) than controls (3%) reported traffic violations within the previous year, the authors report. Among cirrhotic patients, 33% of those with MHE and 4% of those without MHE reported traffic violations or motor vehicle accidents in the prior year.

The differences were similar for the previous 5 years: 53% of cirrhotics with MHE, 23% of cirrhotics without MHE, and 7% of controls reported traffic violations or motor vehicle accidents.

Driving behavior questionnaire (DBQ) scores were significantly higher for controls (mean, 99) than for cirrhotics with MHE (90) but not for cirrhotics without MHE (100), the researchers note. In contrast, personal overall driving assessments did not differ between the groups.

"We believe that MHE patients have several areas of cognitive dysfunction that make them prone to drive poorly," Dr. Bajaj said. "Our MHE research group has just started enrollment in a trial using a non-absorbable antibiotic, rifaximin, on driving ability and quality of life in patients with MHE, which would help clarify the issue of treatment of MHE and driving problems."

"This group is to be congratulated for focusing their research on MHE, a frequent but often overlooked complication of cirrhosis," writes Dr. Santiago J. Munoz from Albert Einstein Medical Center, Philadelphia, Pennsylvania in a related editorial.

"Dietary fiber, probiotics, and even lactulose have been reported to improve MHE," Dr. Munoz points out. "Thus, the hazards of driving with MHE are in theory susceptible of effective treatment."

Am J Gastroenterol 2007;102:1903-1909,1910-1911.