Constipation and upper gastrointestinal bleed: Leading precipitating factors of hepatic encephalopathy in Indian cirrhotic patients

Liver cirrhosis and its complications pose major health problems. In India, commonest causes of cirrhosis are alcohol abuse and viral hepatitis. Hepatic encephalopathy (HE) is a life-threatening complication of cirrhosis. This study aimed to determine clinical, etiological and laboratory profile of chronic liver disease patients presenting with HE. Cross-sectional study was conducted in Institute of Internal Medicine at Madras Medical College, Chennai. Seventy-five diagnosed cases of chronic liver disease presenting with hepatic encephalopathy were enrolled. Hepatic encephalopathy was clinically graded according to West Haven grading. Middle aged group males comprised the largest affected group (30–50 year). Alcohol abuse was most common etiological factor. Jaundice (78%) was most common presenting complaint. Most common precipitating factors were constipation (54%) and upper gastrointestinal (GI) bleeding (45%). Thrombocytopenia was present in 78% cases while 16% cases presented with coagulopathy. The mean serum AST, ALT, bilirubin, ALP and albumin level were 90 U/l, 68.4 U/l, 9.66 mg/dl, 124.2U/l and 2.9 g m/dl, respectively. Mean serum urea and creatinine level were 43.22 mg/dl and 1.39 mg/dl respectively. In the specific study group, alcohol-related chronic liver disease was the commonest, with constipation and upper gastrointestinal bleeding being the leading precipitating factors for hepatic encephalopathy.