Management of hepatic encephalopathy in Germany
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Management of hepatic encephalopathy in Germany : a survey among physicians. / Labenz, Christian; Adarkwah, Charles C; Wörns, Marcus-Alexander; Miehlke, Stephan; Hofmann, Wolf P; Buggisch, Peter; Galle, Peter R; Frieling, Thomas; Labenz, Joachim.
in: Z GASTROENTEROL, Jahrgang 58, Nr. 1, 01.2020, S. 49-56.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Management of hepatic encephalopathy in Germany
T2 - a survey among physicians
AU - Labenz, Christian
AU - Adarkwah, Charles C
AU - Wörns, Marcus-Alexander
AU - Miehlke, Stephan
AU - Hofmann, Wolf P
AU - Buggisch, Peter
AU - Galle, Peter R
AU - Frieling, Thomas
AU - Labenz, Joachim
N1 - © Georg Thieme Verlag KG Stuttgart · New York.
PY - 2020/1
Y1 - 2020/1
N2 - BACKGROUND: Hepatic encephalopathy (HE) is a severe complication of liver cirrhosis with impairment of quality of life and prognosis. Management patterns among physicians have not been investigated yet.METHODS: A questionnaire containing 17 questions was sent out to 1468 gastroenterologists and 120 general practitioners (GPs). It included questions regarding diagnostic, therapeutic, and management strategies used in patients with overt HE (OHE) and covert HE (CHE).RESULTS: The response rate was 12 % (n = 172) for gastroenterologists and 45 % (n = 54) for GPs. Of gastroenterologists, 26.7 % examine patients with an initial diagnosis of liver cirrhosis regarding HE. Gastroenterologists favored a combination of different testing strategies (27.9 %) and clinical examination (23.0 %), while the biggest part of the GPs use clinical examination (55.3 %); 63.7 % of gastroenterologists and 28.3 % of GPs give correct nutritional advices to patients with HE. Treatment strategies for acute bouts of OHE and secondary prophylaxis varied widely in both groups. Preferred medication was lactulose followed by rifaximin or a combination therapy. More than half of the GPs (53.7 %) were not familiar with minimal HE (MHE). About one-third of both groups never tried to diagnose MHE.CONCLUSION: Our data strongly indicate that management of HE is very heterogeneous among gastroenterologists as well as selected GPs working in Germany and not driven by evidence-based international guidelines. Thus, the national guideline is more than welcome.
AB - BACKGROUND: Hepatic encephalopathy (HE) is a severe complication of liver cirrhosis with impairment of quality of life and prognosis. Management patterns among physicians have not been investigated yet.METHODS: A questionnaire containing 17 questions was sent out to 1468 gastroenterologists and 120 general practitioners (GPs). It included questions regarding diagnostic, therapeutic, and management strategies used in patients with overt HE (OHE) and covert HE (CHE).RESULTS: The response rate was 12 % (n = 172) for gastroenterologists and 45 % (n = 54) for GPs. Of gastroenterologists, 26.7 % examine patients with an initial diagnosis of liver cirrhosis regarding HE. Gastroenterologists favored a combination of different testing strategies (27.9 %) and clinical examination (23.0 %), while the biggest part of the GPs use clinical examination (55.3 %); 63.7 % of gastroenterologists and 28.3 % of GPs give correct nutritional advices to patients with HE. Treatment strategies for acute bouts of OHE and secondary prophylaxis varied widely in both groups. Preferred medication was lactulose followed by rifaximin or a combination therapy. More than half of the GPs (53.7 %) were not familiar with minimal HE (MHE). About one-third of both groups never tried to diagnose MHE.CONCLUSION: Our data strongly indicate that management of HE is very heterogeneous among gastroenterologists as well as selected GPs working in Germany and not driven by evidence-based international guidelines. Thus, the national guideline is more than welcome.
KW - Disease Management
KW - Gastroenterologists
KW - Gastrointestinal Agents/therapeutic use
KW - General Practitioners
KW - Germany
KW - Hepatic Encephalopathy/diagnosis
KW - Humans
KW - Lactulose/therapeutic use
KW - Liver Cirrhosis/complications
KW - Practice Patterns, Physicians'/statistics & numerical data
KW - Quality of Life
KW - Rifaximin/therapeutic use
KW - Secondary Prevention/methods
KW - Surveys and Questionnaires
U2 - 10.1055/a-1010-6974
DO - 10.1055/a-1010-6974
M3 - SCORING: Journal article
C2 - 31931540
VL - 58
SP - 49
EP - 56
JO - Z GASTROENTEROL
JF - Z GASTROENTEROL
SN - 0044-2771
IS - 1
ER -