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Comparison of the Effectiveness of Rifaximin plus Lactulose versus Lactulose Alone in Overt Hepatic Encephalopathy in Terms of Complete Reversal

Comparison of the Effectiveness of Rifaximin plus Lactulose versus Lactulose Alone in Overt Hepatic Encephalopathy in Terms of Complete Reversal

Authors

  • Faizan Pervaiz JMU
  • Ali Hyder 2Associate Professor Gastroenterology Department Chandka Medical College SMBBMU Larkana
  • Najam-Us-Sehar Saeed 3Assistant Professor Gastroenterology Gujranwala Teaching Hospital Gujranwala
  • Jawad Naeem Senior Registrar Gastroenterology Gujranwala Teaching Hospital Gujranwala
  • Zain Haide Senior Registrar Gastroenterology Gujranwala Teaching Hospital Gujranwala
  • Daud Ghilzai 6Assistant Professor Department of Gastroenterology Bolan Medical College Quetta

DOI:

https://doi.org/10.37018/JFJMU/5421

Keywords:

Overt Hepatic Encephalopathy, Rifaximin, Lactulose, Reversal of OHE, Model for End-Stage Liver Disease (MELD)

Abstract

Background: Hepatic encephalopathy is a serious complication of liver disease, marked by cognitive impairment and potentially life-threatening consequences. Lactulose has long been a standard treatment, but its effectiveness may be limited. Adding rifaximin to lactulose has shown promising results in managing overt hepatic encephalopathy (OHE). This study compared the frequency of complete reversal of encephalopathy by rifaximin plus lactulose versus lactulose alone in patients with OHE.

Patients and methods: A randomized controlled trial was carried out at Gastroenterology, DHQ, Gujranwala.  The patients diagnosed with hepatic encephalopathy (age range = 18-60 years) were included. On the contrary, patients with serum creatinine of >1.5 mg/dl at admission, diagnosed with hepatocellular carcinoma, active alcohol intake (<4 weeks) and patients with significant comorbidities like CVA, epilepsy, and dementia were excluded from the study were not included in the study. Ninety patients into two equal groups; Group A-B. A patients received a combination therapy of Rifaximin (550mg tablet twice daily) and lactulose (30-60 ml thrice a day). Group B patients received lactulose (30-60 ml thrice times daily) placebo capsule (sugar) thrice daily. Both groups were monitored for achievement of optimal bowel function (two to three semisoft stools per day).

Results: The patients was 44.9 years. Overall there were 66 (73.3%) males 24 (26.7%) females.  The mean MELD scores in group A-B were 33.76 ± 16.76 and 34.36 ± 15.85. The mean duration of liver cirrhosis in group A and group B was 6.49 ± 2.25 and 6.67 ± 2.40, respectively. In group A, a complete reversal of HE was seen in 38 (84.4%) cases while in group B the complete reversal of HE was observed in 24 (53.3%) cases (p-value <0.05).

Conclusion: The combination of Rifaximin with lactulose is more effective in treating overt hepatic encephalopathy compared to lactulose alone in terms of complete reversal.

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Published

2024-04-20

How to Cite

1.
Pervaiz F, Hyder A, Saeed N-U-S, Naeem J, Haide Z, Ghilzai D. Comparison of the Effectiveness of Rifaximin plus Lactulose versus Lactulose Alone in Overt Hepatic Encephalopathy in Terms of Complete Reversal. J Fatima Jinnah Med Univ [Internet]. 2024 Apr. 20 [cited 2024 Jul. 22];18(01):6-9. Available from: http://www.jfjmu.com/index.php/ojs/article/view/1241