ABSTRACT
SUMMARY Introduction: Hepatic encephalopathy (HE) is a bad prognostic factor in patients with liver cirrhosis and its incidence is associated with several triggering factors being the most prevalent gastrointestinal bleeding. Lactulose, despite its questionable efficacy in the literature, is considered a first line treatment in patients with HE. Objective: To evaluate the effectiveness of lactulose in preventing HE in cirrhotic patients with gastrointestinal bleeding. Method: A systematic review of the literature using the Medline scientific database. Only randomized controlled clinical trials evaluating the efficacy of lactulose for HE prophylaxis in cirrhotic patients with gastrointestinal bleeding were included. Results: The incidence of HE in the intervention group was 7%, while the control group was 26% (p=0.01). There was no significant difference in the incidence of mortality in the group treated with lactulose compared to the group that was not treated (p=0.48). Conclusion: Administering lactulose to cirrhotic patients with upper gastrointestinal bleeding reduces the incidence of hepatic encephalopathy.
RSUMO Introdução: encefalopatia hepática (EH) é fator de mau prognóstico no paciente com cirrose hepática e sua incidência está associada a vários fatores desencadeantes, sendo a hemorragia digestiva o mais prevalente. A lactulose, apesar de apresentar eficácia discutível na literatura, é considerada tratamento de primeira linha em pacientes com EH. Objetivo: avaliar a eficácia da lactulose na prevenção de EH em pacientes cirróticos apresentando hemorragia digestiva. Método: realizou-se revisão sistemática da literatura pela base de dados Medline. Foram incluídos apenas ensaios clínicos controlados e randomizados que avaliaram a eficácia da lactulose na profilaxia de EH em pacientes cirróticos com hemorragia digestiva. Resultados: a incidência de EH no grupo intervenção foi de 7% enquanto no grupo controle foi de 26% (p=0,01). Não houve diferença significante na incidência de mortalidade entre o grupo que recebeu lactulose e o que não recebeu (p=0,48). Conclusão: a administração de lactulose em pacientes cirróticos apresentando hemorragia digestiva alta diminui a incidência de encefalopatia hepática.
Subject(s)
Humans , Male , Female , Gastrointestinal Agents/therapeutic use , Hepatic Encephalopathy/prevention & control , Gastrointestinal Hemorrhage/drug therapy , Lactulose/therapeutic use , Liver Cirrhosis/drug therapy , Randomized Controlled Trials as Topic , Hepatic Encephalopathy/mortality , Reproducibility of Results , Treatment Outcome , Gastrointestinal Hemorrhage/mortality , Liver Cirrhosis/mortalityABSTRACT
To determine the efficacy of Rifaximin in prevention of repeated episodes of hepatic encephalopathy in patients with liver cirrhosis as compared to placebo. Triple-blind, randomized placebo-controlled trial. Department of Gastroenterology-Hepatology, Shaikh Zayed Hospital, Lahore, from October 2012 to April 2013. Patients in remission from recurrent hepatic encephalopathy resulting from cirrhosis were randomly assigned to receive either Rifaximin, at a dose of 550 mg twice daily [63 patients], or placebo [63 patients.] Patients were requested to take the drug orally twice daily for 6 months or until they developed a breakthrough episode of hepatic encephalopathy. Mean age of patients in treatment and control group was 40.21 +/- 2.33 years and 42.87 +/- 4.54 years respectively. The most common etiology of cirrhosis was hepatitis C followed by hepatitis B. Patients who remained free of hepatic encephalopathy during study period were 40 out of 63 patients in control group and 35 patients out of 63 patients [p = 0.56]. Most of the patients who developed breakthrough hepatic encephalopathy had a MELD score range of 21-25 in both groups. The number of deaths and adverse events was similar in both groups. Over a 6-month period, treatment with Rifaximin failed to maintain remission from hepatic encephalopathy more effectively than placebo in the studied group.