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Z Gastroenterol 2020; 58(01): 49-56
DOI: 10.1055/a-1010-6974
Originalarbeit
© Georg Thieme Verlag KG Stuttgart · New York

Management of hepatic encephalopathy in Germany: a survey among physicians

Management der hepatischen Enzephalopathie in Deutschland: eine Umfrage unter Gastroenterologen und Allgemeinmedizinern
Christian Labenz
1   Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
,
Charles C. Adarkwah
2   Department of Health Services Research and General Practice, Faculty of Life Sciences, University of Siegen, Siegen, Germany
3   Department of General Practice and Family Medicine, Philipps-University, Marburg, Germany
,
Marcus-Alexander Wörns
1   Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
,
Stephan Miehlke
4   Center for Digestive Diseases, Internal Medicine Center Eppendorf, Hamburg, Germany
,
Wolf P. Hofmann
5   Practice of Gastroenterology, Berlin, Germany
,
Peter Buggisch
6   Asklepios Klinik St. Georg Haus L, IFI Institut für Interdisziplinäre Medizin, Hamburg, Germany
,
Peter R. Galle
1   Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
,
Thomas Frieling
7   Department of Internal Medicine and Gastroenterology, Helios Klinikum Krefeld, Krefeld, Germany
,
Joachim Labenz
8   Department of Internal Medicine, Diakonie Klinikum Jung-Stilling, Siegen, Germany
› Author Affiliations
Further Information

Publication History

13 July 2019

04 September 2019

Publication Date:
13 January 2020 (online)

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Abstract

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.

Zusammenfasung

Einleitung Die hepatische Enzephalopathie (HE) ist eine schwerwiegende Komplikation der Leberzirrhose. Das Management der HE durch deutsche Ärzte wurde bisher nicht untersucht.

Methoden Ein elektronischer Fragebogen mit 17 Fragen wurde an 1468 Gastroenterologen und an 120 Hausärzte versendet. Der Fragebogen beinhaltete Fragen zum Management bei Patienten mit overter HE (OHE) und covert HE (CHE).

Ergebnisse Die Rücksenderate war 12 % (n = 172) für Gastroenterologen und 45 % (n = 54) für Allgemeinmediziner. 26,7 % aller Gastroenterologen gaben an, ihre Patienten bei Erstdiagnose einer Leberzirrhose immer auf das Vorliegen einer HE zu untersuchen. Während Gastroenterologen eine Kombination verschiedener Testverfahren (27,9 %) bzw. eine alleinige klinische Untersuchung (23,0 %) einsetzen, diagnostizieren Hausärzte die HE vorrangig klinisch (55,3 %). 63,7 % der Gastroenterologen und 28,3 % der Hausärzte geben Patienten mit einer HE korrekte Ernährungsempfehlungen. Die Strategien zur Behandlung und zur Sekundärprophylaxe waren in beiden Gruppen sehr heterogen. Die bevorzugte Medikation war Lactulose, gefolgt von Rifaximin und einer Kombinationsbehandlung. 53,7 % der Hausärzte waren mit der minimalen HE (MHE) nicht vertraut.

Schlussfolgerung Die Ergebnisse dieser Umfrage zeigen, dass das diagnostische und therapeutische Management der HE sowohl unter in Deutschland tätigen Gastroenterologen als auch Hausärzten ausgesprochen uneinheitlich ist und die 2014 publizierte internationale Leitlinie nicht umgesetzt wird.

Key words

liver cirrhosis - brain dysfunction - end-stage liver disease - medical treatment

Schlüsselwörter

Leberzirrhose - Hirndysfunktion - terminale Lebererkrankung - medikamentöse Behandlung
 

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