Heiser C, Haller B, Sohn M, Hofauer B, Knopf A, Mühling T, Freiherr J, Bender M, Tiller M, Schmidt A, Schepp W, Gundling F

Language: English
References: 21
Page: 822-829
PDF size: 252.87 Kb.

ABSTRACT

Introduction and aim. Olfactory functions are altered to a variable degree by chronic liver disease. Few studies including only small populations of patients emphasized the possibility of hepatic encephalopathy (HE) influencing olfactory nervous tasks. So far, no study has explicitly focused on olfactory function depending on the severity of HE as assessed by objective diagnostic procedures. Thus we performed a study using the “Sniffin’ Sticks” test system, critical flicker-fusion frequency (CFF) and clinical West Haven criteria. Material and methods. 54 cirrhotic patients with liver cirrhosis were included. Furthermore, 43 adult volunteers participating as a non-cirrhotic control group. Olfactory testing was performed using the “Sniffin’ Stick” test battery (Burghart Medizintechnik, Wedel, Germany) which renders a widely-used tool both in clinical and research settings for the assessment of olfactory threshold, odor identification and discrimination. Several complications of cirrhosis were diagnosed by reference methods. Statistical analysis of cirrhosis-associated complications and their relation to olfactory function was performed. Assessment of HE and classification of different stages were performed according to clinical criteria (West– Haven criteria) and according to CFF, which was determined using a portable analyzer. Results. Olfactory function was significantly reduced in cirrhotic patients (in 61.1%) compared to controls (p ‹ 0.001). Among cirrhotics patients, the prevalence of olfactory deficits (hyposmia, anosmia) increased with the severity of HE as assessed by CFF and clinical criteria (p = 0.008 and p = 0.097, respectively). No correlation was observed between olfactory deficits and severity of liver disease as assessed by Child-Pugh-Score, etiology of cirrhosis and complications of cirrhosis such as ascites and portal venous hypertension. Conclusions. Olfactory testing serves as a screening tool for HE and may faciliate grading of HE-severity.

REFERENCES

1. Dhiman RK, Saraswat VA, Sharma BK, Sarin SK, Chawla YK, Butterworth R, Duseja A, et al.; Indian National Association for Study of the Liver. Minimal hepatic encephalopathy: Consensus statement of a working party of the Indian National Association for Study of the Liver. J Gastroenterol Hepatol 2010; 25: 1029-41.

2. Bloomfeld RS, Graham BG, Schiffman SS, Killenberg PG. Alterations of chemosensory function in end-stage liver disease. Physiol Behav 1999; 66: 203-7.

3. Gundling F, Seidl H, Pehl C, Schmidt T, Schepp W. How close do gastroenterologists follow specific guidelines for nutrition recommendations in liver cirrhosis? A survey of current practice. Eur J Gastroenterol Hepatol 2009; 21: 756-61.

4. Madden AM, Bradbury W, Morgan MY. Taste perception in cirrhosis: its relationship to circulating micronutrients and food preferences. Hepatol 1997; 26: 40-8.

5. Burch RE, Sackin DA, Ursick JA, Jetton MM, Sullivan JF. Decreased taste and smell acuity in cirrhosis. Arch Intern Med 1978; 138: 743-6.

6. Temmel AF, Pabinger S, Quint C, Munda P, Ferenci P, Hummel T. Dysfunction of the liver affects the sense of smell. Wien Klin Wochenschr 2005; 117: 26-30.

7. Zucco GM, Amodio P, Gatta A. Olfactory deficits in patients affected by minimal hepatic encephalopathy: a pilot study. Chem Senses 2006; 31: 273-8.

8. Ferenci P, Lockwood A, Mullen K, Tarter R, Weissenborn K, Blei AT. Hepatic encephalopathy – definition, nomenclature, diagnosis, and quantification: final report of the working party at the 11th World Congress of Gastroenterology, Vienna, 1998. Hepatol 2002; 35: 716-21.

9. Gundling F, Schmidtler F, Hapfelmeier A, Schulte B, Schmidt T, Pehl C, Schepp W, Seidl H. Fecal calprotectin is a useful screening parameter for hepatic encephalopathy and spontaneous bacterial peritonitis in cirrhosis. Liver Int 2011; 31: 1406-15.

10. Kircheis G, Wettstein M, Timmermann L, Schnitzler A, Haussinger D. Critical flicker frequency for quantification of lowgrade hepatic encephalopathy. Hepatol 2002; 35: 357-66.

11. Kircheis G, Hilger N, Häussinger D. Value of critical flicker frequency and psychometric hepatic encephalopathy score in diagnosis of low-grade hepatic encephalopathy. Gastroenterol 2014; 146: 961-9.

12. Hummel T, Futschik T, Frasnelli J, Hüttenbrink KB. Effects of olfactory function, age, and gender on trigeminally mediated sensations: a study based on the lateralization of chemosensory stimuli. Toxicol Lett 140: 273-80.

13. Wolfensberger M, Schnieper I, Welge-Lüssen A. Sniffin’Sticks: a new olfactory test battery. Acta Otolaryngol 2000; 120: 303-6.

14. Stuck BA, Beule A, Damm M, Gudziol H, Hüttenbrink KB, Landis BN, Renner B, et al.; Committee on Olfaction and Gustation of the German Society of Otorhinolaryngology, Head and Neck Surgery. [Position paper Chemosensory testing for expert opinion in smell disorders]. Laryngorhinootol 2014; 93: 327-9.

15. Butterworth RF. The neurobiology of hepatic encephalopathy. Semin Liver Dis 1996; 16: 235-44.

16. Butterworth RF, Giguère JF, Michaud J, Lavoie J, Layrargues GP. Ammonia: a key factor in the pathogenesis of hepatic encephalopathy. Neurochem Pathol 1987; 6: 1-12.

17. Trombley PQ, Shepherd GM. Synaptic transmission and modulation in the olfactory bulb. Curr Opin Neurobiol 993; 3: 540-7.

18. Behar KL, Rothman DL, Petersen KF, Hooten M, Delaney R, Petroff OA, Shulman GI, et al. Preliminary evidence of low cortical GABA levels in localized 1H-MR spectra of alcoholdependent and hepatic encephalopathy patients. Am J Psychiatry 1999; 156: 952-4.

19. Krieger D, Krieger S, Jansen O, Gass P, Theilmann L, Lichtnecker H. Manganese and chronic hepatic encephalopathy. Lancet 346: 270-4.

20. Berkowicz DA, Trombley PQ. Dopaminergic modulation at the olfactory nerve synapse. Brain Res 2000; 855: 90-9.

21. Doty RL. Olfaction. Annu Rev Psychol 2001; 52: 423-542.