Phd in EXPERIMENTAL AND CLINICAL HEPATO-GASTROENTEROLOGY

Thesis title: Studio pilota sull’impatto e sulle strategie terapeutiche dell’encefalopatia epatica minima

Minimal hepatic encephalopathy (MHE) is a frequent complication of liver cirrhosis, and several studies have documented a high prevalence of this condition among patients with sarcopenia. The aims of this study are to evaluate the clinical impact of liver cirrhosis and the effect of combining a balanced diet with standardized physical exercise on muscle mass, cognitive performance, and the risk of developing overt hepatic encephalopathy. The latter objective is based on the EASL recommendations for nutrition in cirrhotic patients, which suggest a daily caloric intake of 30–35 Kcal/kg/day for non-obese patients and 20–25 Kcal/kg/day for obese patients, divided into 4–6 daily meals. The study population consists of ambulatory cirrhotic patients followed at the Gastroenterology Unit of S.M. Goretti Hospital in Latina, diagnosed with MHE according to the PHES and/or with sarcopenia based on ultrasound parameters, aged under 75 years, with cirrhosis classified as Child-Pugh A or B, and without TIPS, hepatocellular carcinoma, or conditions that could limit physical activity, such as cardiorespiratory or musculoskeletal disorders and refractory ascites. At baseline assessment, patients undergo clinical, anthropometric, nutritional, and behavioral evaluations, including the completion of a food diary. In addition, a battery of questionnaires is administered to assess quality of life (SF-36), frailty, fatigue (Fatigue Severity Scale), and mood (ZUNG test, STAI-1 and STAI-2). The risk of falls is also evaluated using the Timed Up and Go test. Finally, an ultrasound of the rectus femoris muscle is performed, adopting a cut-off of 20 mm for males and 16 mm for females for the diagnosis of sarcopenia. After the initial evaluation, patients receive a personalized diet plan adjusted for body weight and BMI, as well as an illustrated guide for performing home-based physical exercises. The duration of the intervention is six months. At the end of the program, patients undergo clinical and biochemical reassessment, all tests and self-assessment questionnaires are repeated, major events and exercise-related complications are recorded, and a repeat ultrasound of the rectus femoris muscle is performed.