Minimal Hepatic Encephalopathy in Cirrhosis- How Long to Treat?
Ann. hepatol
; 16(1): 115-122, Jan.-Feb. 2017. graf
Artigo
em Inglês
| LILACS
| ID: biblio-838093
Biblioteca responsável:
BR1.1
ABSTRACT
Abstract Introduction. Minimal hepatic encephalopathy (MHE) can reverse after short-term treatment. However, relapse rate of MHE after stopping treatment has not been studied so far. We aimed to evaluate long-term (9 months) efficacy of a short-term (3 months) treatment of MHE with lactulose/rifaximin, for maintenance of remission from MHE. Material and methods. In this prospective study, consecutive patients with cirrhosis and MHE were treated with lactulose/rifaximin for 3 months. After treatment, they were followed up for 6 months. Psychometric testing for diagnosis of MHE was performed at baseline, 3 months and 9 months. Results. Of the 527 patients screened, 351 were found eligible and tested for MHE. Out of these, 112 (31.9%) patients had MHE (mean age 55.3 years; 75% males). They were randomized to receive Rifaximin (n = 57; 1,200 mg/day) or Lactulose (n = 55; 30-120 mL/day) for three months. At 3 months, 73.7% (42/57) patients in Rifaximin group experienced MHE reversal compared to 69.1% (38/55) in Lactulose group (p = 0.677). Six months after stopping treatment, 47.6% (20/42) in rifaximin group and 42.1% (16/38) patients in lactulose group experienced MHE relapse (p = 0.274). The overt hepatic encephalopathy development rate (7.1% vs. 7.9%) and mortality rate (0.23% vs. 0%) were similar in both groups. The Child-Turcotte-Pugh score and model for end stage liver disease (MELD) scores of patients who had MHE relapse were higher compared to those who didn’t. On multivariate regression analysis, MELD score was an independent predictor of MHE relapse. Conclusion. Of the patients who became MHE negative after short-term (3 months) treatment with rifaximin/lactulose, almost 50% had a relapse of MHE at 6 months follow-up.
Texto completo:
Disponível
Coleções:
Bases de dados internacionais
Contexto em Saúde:
ODS3 - Saúde e Bem-Estar
/
ODS3 - Meta 3.4 Reduzir as mortes prematuras devido doenças não transmissíveis
/
ODS3 - Meta 3.2 Reduzir as mortes de recém nascidos e crianças com menos de 5 anos
Problema de saúde:
Meta 3.2: Reduzir as mortes de recém nascidos e crianças com menos de 5 anos
/
Cirrose
/
Doenças do Sistema Digestório
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Doenças do Sistema Endócrino
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Cuidados de Saúde Neonatal
Base de dados:
LILACS
Assunto principal:
Rifamicinas
/
Encefalopatia Hepática
/
Lactulose
/
Cirrose Hepática
Tipo de estudo:
Ensaio clínico controlado
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Estudo diagnóstico
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Estudo de etiologia
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Estudo observacional
/
Estudo prognóstico
/
Fatores de risco
Limite:
Humanos
País/Região como assunto:
Ásia
Idioma:
Inglês
Revista:
Ann. hepatol
Assunto da revista:
Gastroenterologia
Ano de publicação:
2017
Tipo de documento:
Artigo
País de afiliação:
Índia
Instituição/País de afiliação:
Dayanand Medical Collegeand Hospital/IN