Evidence map›Paper›PMID 40053108›Full record

ArticleJournal of gastroenterology2025

Current management and future perspectives of covert hepatic encephalopathy in Japan: a nationwide survey.

Takao Miwa, Mio Tsuruoka, Hajime Ueda, Tamami Abe, Hiroki Inada, Yoshimi Yukawa-Muto, Masatsugu Ohara, Taeang Arai, Yasuyuki Tamai, Hiroshi Isoda and 26 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Journal of gastroenterology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed.

  1. Review
  2. Review
  3. Article
  4. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

36 authors.

Takao MiwaDepartment of Gastroenterology/Internal Medicine, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan. miwa.takao.a6@f.gifu-u.ac.jp.ORCID 0000-0002-6373-260X
Mio TsuruokaDivision of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-Machi, Aoba-Ku, Sendai, 980-8574, Japan.
Hajime UedaDivision of Gastroenterology and Hepatology, Tokyo Medical University Ibaraki Medical Center, 3-20-1 Chuo, Ami-Machi, Inashiki-Gun, Ibaraki, 300-3095, Japan.
Tamami AbeDivision of Gastroenterology and Hepatology, Department of Internal Medicine, Iwate Medical University, Iwate Medical University School of Medicine, Nishitokuta 2-1-1, Yahaba-Cho, Shiwa-Gun, Yahaba, Iwate, 028-3694, Japan.
Hiroki InadaDepartment of Gastroenterology and Hepatology, Faculty of Life Sciences, Kumamoto University, Kumamoto University, 1-1-1, Honjo, Chuo-Ku, Kumamoto, 860-8556, Japan.
Yoshimi Yukawa-MutoDepartment of Hepatology, Graduate School of Medicine, Osaka Metropolitan University, 1-4-3 Asahimachi, Abeno-Ku, Osaka, 545-8585, Japan.
Masatsugu OharaDepartment of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, Kita-15 Nishi-7, Kita-Ku, Sapporo-Shi, Hokkaido, 060-8638, Japan.
Taeang AraiDivision of Gastroenterology and Hepatology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan.
Yasuyuki TamaiDepartment of Gastroenterology and Hepatology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, 514-8507, Japan.
Hiroshi IsodaLiver Center, Saga University Hospital, 5-1-1 Nabeshima, Saga, 849-8501, Japan.
Tomoko TadokoroDepartment of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki, Kita, Takamatsu, Kagawa, 761-0793, Japan.
Tatsunori HanaiDepartment of Gastroenterology/Internal Medicine, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan.
Takanori ItoDepartment of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa, Nagoya, 466-8550, Japan.
Nobuharu TamakiDepartment of Gastroenterology and Hepatology, Musashino Red Cross Hospital, 1-26-1Kyonan-Cho, Musashino-Shi, Tokyo, 180-8610, Japan.
Akira SakamakiDivision of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, 1-757 Asahimachidori, Chuo-Ku, Niigata, 951-8510, Japan.
Yoshihiko AokiKohnodai Hospital, National Center for Global Health and Medicine, 1-7-1, Kohnodai, Ichikawa, 272-8516, Japan.
Fujimasa TadaGastroenterology Center, Ehime Prefectural Central Hospital, 83 Kasuga-Cho, Matsuyama, Ehime, 790-0024, Japan.
Sachiyo YoshioDepartment of Human Immunology and Translational Research, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjuku-Ku, Tokyo, 162-8655, Japan.
Hirokazu TakahashiLiver Center, Saga University Hospital, 5-1-1 Nabeshima, Saga, 849-8501, Japan.
Asahiro MorishitaDepartment of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki, Kita, Takamatsu, Kagawa, 761-0793, Japan.
Tsuyoshi IshikawaDepartment of Gastroenterology and Hepatology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube-Yamaguchi, 7558505, Japan.
Jun InoueDivision of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-Machi, Aoba-Ku, Sendai, 980-8574, Japan.
Goki SudaDepartment of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, Kita-15 Nishi-7, Kita-Ku, Sapporo-Shi, Hokkaido, 060-8638, Japan.
Chikara OgawaDepartment of Gastroenterology and Hepatology, Takamatsu Red Cross Hospital, Takamatsu, 4-1-3 Bancho, Takamatsu City, Kagawa Prefecture, 760-0017, Japan.
Masanori AtsukawaDivision of Gastroenterology and Hepatology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan.
Atsushi HiraokaGastroenterology Center, Ehime Prefectural Central Hospital, 83 Kasuga-Cho, Matsuyama, Ehime, 790-0024, Japan.
Hidekatsu KurodaDivision of Gastroenterology and Hepatology, Department of Internal Medicine, Iwate Medical University, Iwate Medical University School of Medicine, Nishitokuta 2-1-1, Yahaba-Cho, Shiwa-Gun, Yahaba, Iwate, 028-3694, Japan.
Tadashi NamisakiDepartment of Gastroenterology, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8521, Japan.
Takashi HondaDepartment of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa, Nagoya, 466-8550, Japan.
Takumi KawaguchiDivision of Gastroenterology, Department of Medicine, Kurume University School of Medicine, 67 Asahi-Machi, Kurume, 830-0011, Japan.
Yasuhito TanakaDepartment of Gastroenterology and Hepatology, Faculty of Life Sciences, Kumamoto University, Kumamoto University, 1-1-1, Honjo, Chuo-Ku, Kumamoto, 860-8556, Japan.
Shuji TeraiDivision of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, 1-757 Asahimachidori, Chuo-Ku, Niigata, 951-8510, Japan.
Tadashi IkegamiDivision of Gastroenterology and Hepatology, Tokyo Medical University Ibaraki Medical Center, 3-20-1 Chuo, Ami-Machi, Inashiki-Gun, Ibaraki, 300-3095, Japan.
Hitoshi YoshijiDepartment of Gastroenterology, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8521, Japan.
Motoh IwasaDepartment of Gastroenterology and Hepatology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, 514-8507, Japan.
Masahito ShimizuDepartment of Gastroenterology/Internal Medicine, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan.

Funding

Japan Agency for Medical Research and Development 24fk0210154Japan Society for the Promotion of Science JP24K18908
6 · The paper itself

Abstract

backgroundCovert hepatic encephalopathy (CHE) leads to devastating outcomes in patients with cirrhosis. This study aims to elucidate the current management and future perspectives of CHE in Japan.

methodsA questionnaire-based cross-sectional study was conducted among physicians involved in managing cirrhosis in Japan. The primary aim was to elucidate the real-world management of CHE, including testing and treatment. Factors influencing the implementation of CHE testing were analyzed using a logistic regression model. Limitations and future perspectives for improving the management of CHE were also evaluated.

resultsOf 511 physicians surveyed, 93.9% recognized CHE as a significant problem, and 86.9% agreed that it should be tested. Overall, 62.8% of physicians tested for CHE, whereas 37.2% did not. Multivariable analysis identified institutional factors and certifying board as significant determinants of CHE test implementation. The Stroop (68.2%) and neuropsychiatric tests (57.5%) were the most commonly used methods of identifying CHE. Among those who tested for CHE, 87.7% treated CHE; the most common treatments were lactulose (81.5%), rifaximin (76.3%), and branched-chain amino acids (70.4%). Among non-testers, the primary barrier was the time requirement for testing. Proposals to encourage CHE testing included the development of simple tests and integration of multidisciplinary teams.

conclusionsMost physicians involved in cirrhosis care in Japan recognize CHE as a significant problem that warrants testing. However, testing for CHE remains limited by institutional factors and physician specialties. Time requirements for CHE testing are the primary barrier, and simple tests and multidisciplinary teams are recommended to enhance CHE management.

Indexed as

Hepatic EncephalopathyLiver CirrhosisPractice Patterns, Physicians'AdultAmino Acids, Branched-ChainCross-Sectional StudiesFemaleGastrointestinal AgentsHumansJapanLactuloseMaleMiddle AgedNeuropsychological TestsRifaximinSurveys and QuestionnairesAmino Acids, Branched-ChainGastrointestinal AgentsLactuloseRifaximinAnimal naming testLiver cirrhosisMinimal hepatic encephalopathyMultidisciplinary teamStroop test

Identifiers

PMID40053108
PMCPMC12177000

What Socratic holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.