RESUMO
Hepatic encephalopathy [HE] is one of the common complications of liver cirrhosis. Lactulose is conventionally used for the treatment of hepatic encephalopathy
Aims and methods: The aim of this study was to evaluate the combined efficacy of lactulose plus rifaximin versus lactulose alone in the management of hepatic encephalopathy. 80 patients with HE were given lactulose alone and another 80 were given a combination of lactulose and rifaximin. They were monitored for 7 days for response i.e., reversal of HE
Results: Initially 160 patients with HE, who met inclusion and exclusion criteria, were enrolled in this study [out of 183 screened]. 80 patients were randomized in lactulose plus rifaximin group [group A] while the other 80 were placed in lactulose alone group [group B]
Patients were given respective treatment and were monitored for improvement of HE by using West Haven [WH] criteria. Patients were assessed daily. Patients were monitored till recovery or death for 7 days, whichever occurred first. 62 [77.5%] patients in the rifaximin plus lactulose group showed reversal while 43[53.75%] patients in lactulose only group showed reversal of HE. Mortality was also less in the rifaximin plus lactulose group compared to lactulose alone group 17[21.25%] vs. 33 [41.25%] respectively [P<0.05]
Conclusion: Rifaximin and lactulose have different mechanisms of action and act synergistically in combination and show better response in treating HE. This can result in significant decrease in morbidity and mortality