Lucas IC, Domingues AL, Filgueira NA, Lopes EP, Albuquerque IKP, Pereira CLD. Minimal hepatic encephalopathy in hepatosplenic schistosomiasis: High prevalence and association with portosystemic shunts in a Brazilian cross-sectional study. World J Hepatol 2025; 17(12): 113078 [DOI: 10.4254/wjh.v17.i12.113078]
Corresponding Author of This Article
Iris Campos Lucas, PhD, Professor, Programa de Pós-graduação em Medicina Tropical, Universidade Federal de Pernambuco, Avenida Professor Moraes Rego, 1235, Cidade Universitária, Recife 50670-901, Pernambuco, Brazil. iriscamposlucas@gmail.com
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Gastroenterology & Hepatology
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Observational Study
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Dec 27, 2025 (publication date) through Dec 29, 2025
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World Journal of Hepatology
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1948-5182
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Lucas IC, Domingues AL, Filgueira NA, Lopes EP, Albuquerque IKP, Pereira CLD. Minimal hepatic encephalopathy in hepatosplenic schistosomiasis: High prevalence and association with portosystemic shunts in a Brazilian cross-sectional study. World J Hepatol 2025; 17(12): 113078 [DOI: 10.4254/wjh.v17.i12.113078]
World J Hepatol. Dec 27, 2025; 17(12): 113078 Published online Dec 27, 2025. doi: 10.4254/wjh.v17.i12.113078
Minimal hepatic encephalopathy in hepatosplenic schistosomiasis: High prevalence and association with portosystemic shunts in a Brazilian cross-sectional study
Iris Campos Lucas, Ana L Domingues, Norma Arteiro Filgueira, Edmundo P Lopes, Ianca Karine Prudencio Albuquerque, Caroline Louise Diniz Pereira
Iris Campos Lucas, Ianca Karine Prudencio Albuquerque, Caroline Louise Diniz Pereira, Programa de Pós-graduação em Medicina Tropical, Universidade Federal de Pernambuco, Recife 50670-901, Pernambuco, Brazil
Iris Campos Lucas, Ana L Domingues, Norma Arteiro Filgueira, Edmundo P Lopes, Departamento de Gastroenterologia, Hospital das Clínicas/EBSERH, Universidade Federal de Pernambuco, Recife 50670-901, Pernambuco, Brazil
Ana L Domingues, Norma Arteiro Filgueira, Edmundo P Lopes, Centro de Ciências Médicas, Universidade Federal de Pernambuco, Recife 50670-901, Pernambuco, Brazil
Co-first authors: Iris Campos Lucas and Ana L Domingues.
Author contributions: Lucas IC and Domingues AL contribute equally to this study as co-first authors; Filgueira NA, Lucas IC and Lopes EP conceptualized and refined the study design; Lucas IC collected the clinical data and performed the psychometric tests; Domingues AL conducted the ultrasound examinations; Lucas IC and Albuquerque IKP analyzed the data and performed the statistical analyses; Lucas IC drafted the manuscript; Lopes EP, Filgueira NA, Domingues AL and Albuquerque IKP critically reviewed and revised the manuscript; all authors read and approved the definitive version of the manuscript.
Institutional review board statement: The study was reviewed and approved by the Ethics Committee of Universidade Federal de Pernambuco (Approval No. 4.958.385).
Informed consent statement: All study participants provided written informed consent prior to their enrollment in the study.
Conflict-of-interest statement: The authors declare no conflicts of interest related to this study.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Data sharing statement: The datasets generated and analyzed during the current study are available from the corresponding author upon reasonable request. Due to the nature of the data, which contains information that could compromise the privacy of research participants, they are not publicly available.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Iris Campos Lucas, PhD, Professor, Programa de Pós-graduação em Medicina Tropical, Universidade Federal de Pernambuco, Avenida Professor Moraes Rego, 1235, Cidade Universitária, Recife 50670-901, Pernambuco, Brazil. iriscamposlucas@gmail.com
Received: August 14, 2025 Revised: August 31, 2025 Accepted: November 10, 2025 Published online: December 27, 2025 Processing time: 134 Days and 10.6 Hours
Abstract
BACKGROUND
Hepatic encephalopathy (HE) is a poorly understood complication in hepatosplenic schistosomiasis (HSS), a neglected cause of non-cirrhotic portal hypertension. Although portosystemic shunts (PSS) are commonly observed in HSS patients, the prevalence and clinical impact of overt HE (OHE) and minimal HE (MHE) remain understudied, particularly in resource-limited settings.
AIM
To determine OHE/MHE prevalence in HSS and its associations with PSS, clinical, and laboratory characteristics.
METHODS
This cross-sectional study included 200 HSS patients undergoing treatment at the Hospital of Universidade Federal de Pernambuco in Brazil between 2021 and 2023. Cognitive function was assessed using the animal naming test (ANT) and Mini-Mental State Examination (MMSE), while psychological status was evaluated with the Hospital Anxiety and Depression Scale. PSS was identified via ultrasound, and fibrosis severity was quantified using the Coutinho index (CI). Analyses were adjusted for education level and the presence of comorbidities. Statistical analyses were performed using R software.
RESULTS
The prevalence of OHE was 0.5%, while MHE, diagnosed via ANT, affected 24% of patients. ANT positivity was significantly associated with the presence of PSS (35.1% vs 15.1%; P = 0.0018) and higher CI scores (1.79 ± 0.26 vs 1.30 ± 0.84; P = 0.045). Patients with MHE demonstrated notably lower MMSE scores (24.06 ± 1.17 vs 26.04 ± 0.63; P = 0.0003), independent of education level. The ANT showed high diagnostic robustness, even among patients with limited formal education.
CONCLUSION
MHE is prevalent in HSS, especially with PSS, and is associated with portal hypertension severity. The ANT enables practical screening, underscoring the need for routine assessment to improve outcomes.
Core Tip: This pioneering study establishes a high prevalence (24%) of minimal hepatic encephalopathy (MHE) in hepatosplenic schistosomiasis (HSS), a neglected tropical disease. We use the animal naming test as a simple, culture-fair, and education-resistant tool for MHE screening in endemic, resource-limited areas. A key innovative finding is the association between MHE, portosystemic shunts, and the Coutinho index, suggesting a combined screening approach. This mandates a paradigm shift towards routine cognitive screening in HSS to mitigate the significant burden of neurocognitive impairment in this neglected population.
