Editorial: rifaximin in cirrhosis—is this what we've been waiting for? Authors’ reply

Abstract

It is not unreasonable to presume that as HE is directly associated with increased morbidity and mortality, that the treatment of HE may result in the reverse. Decreased incidence of HE may be associated with improved nutrition, mobility, compliance with medications and diet, decreased complications such as aspiration, hospitalisations, sepsis, etc.Overall, this was a nice study with that provides further data that rifaximin may be associated with decreased cirrhotic complications and improved survival in those with HE. Future long-term clinical trials are needed to target those without HE and with or without other cirrhotic decompensation, in order to evaluate whether or not rifaximin can decrease risk of progression or delay initial decompensation. ACKNOWLEDGEMENTSDeclaration of personal interests: None. FUN DING INF ORMATION None.O R C I D J. Huang http://orcid.org/0000-0001-8240-8082 failed to show a statistically significant survival benefit of rifaximin in the HCC cohort, even after adjustment for treatment selection bias using inverse probability weighting based on propensity scores of the study patients. As is well-known from previous studies 3-6 ChildTurcotte-Pugh class and TNM stage were determined to be independent predictors for overall survival in the HCC cohort, suggesting that residual liver function and the tumour itself have profound impact on the prognosis of patients with HCC.In our current study, we included and analysed only decompensated cirrhotic patients who had experienced hepatic encephalopathy, one of the representative complications of cirrhosis. As a result, no conclusion can be drawn as to whether rifaximin treatment can yield clinical benefits in overall survival and lowering risks of cirrhotic complications in patients with compensated cirrhosis. In response to Dr. Huang et al's comments, we have conducted further subgroup analyses to verify this issue within our study population. We categorised the patients in the non-HCC cohort into the two subgroups according to the presence of ascites at baseline, which is another representative cir-