NEW YORK (Reuters Health) Aug 09 - In patients with cirrhosis secondary to hepatitis C virus (HCV) infection, comorbidity with diabetes is associated with earlier onset and greater severity of hepatic encephalopathy, according to results of a prospective study.

If confirmed by further research, the association between diabetes and hepatic encephalopathy "has potential important therapeutic implications," Dr. Samuel H. Sigal and his team indicate.

Increased ammonia levels caused by gut bacteria or kidney dysfunction are believed to be contributing factors associated with hepatic encephalopathy, Dr. Sigal and his colleagues point out in their report, published in the American Journal of Gastroenterology. Moreover, they add, constipation often precedes the development of hepatic encephalopathy.

They theorize that diabetes predisposes a cirrhotic patient to hepatic encephalopathy and its exacerbation by increasing ammonia levels as a result of delayed gastric emptying and slowed intestinal motility contributing to bacterial overgrowth.

To test this hypothesis, Dr. Sigal, from the New York Weill Cornell Medical Center, and colleagues at the Mount Sinai School of Medicine in New York, recruited 65 ambulatory patients from a liver transplant program, who had HCV-related cirrhosis. Eleven (17%) had no evidence of hepatic encephalopathy, 33 had mild hepatic encephalopathy, and 21 had severe hepatic encephalopathy.

Twenty patients had diabetes, including one (5%) who had no hepatic encephalopathy, seven (35%) who had mild hepatic encephalopathy, and 12 (60%) who had severe hepatic encephalopathy.

Diabetics had significantly more severe hepatic encephalopathy, at earlier stages of biochemical decompensation and portal hypertension, compared with nondiabetic subjects. However, the investigators discerned no relationship between cirrhosis severity and hepatic encephalopathy.

These findings "emphasize the importance of optimizing diabetic control," Dr. Sigal's group writes.

They caution that their study included only cirrhotic patients with HCV and so it "should not be interpreted to imply that the presence of diabetes is invariably associated with hepatic encephalopathy."

On the other hand, they maintain, "If uncontrolled diabetes, autonomic neuropathy, and/or bacterial overgrowth contribute to hepatic encephalopathy, these factors should be applicable to liver diseases of all etiologies."

Am J Gastroenterol 2006;101:1490-1496.

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