Rifaximin vs. lactulose in treatment of minimal hepatic encephalopathy

Sidhu, Sandeep Singh; Goyal, Omesh; Parker, Richard; Kishore, Harsh; Sood, Ajit

doi:10.1111/liv.12921

Cited by 53 publications

(47 citation statements)

References 28 publications

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“…Lactulose showed significant reduction in serum, liver and brain ammonia levels. The present results are consistent with the previous study reporting that lactulose could significantly lower the level of hyperammonemia [16].…”

Section: Discussionsupporting

confidence: 94%

Curative role of lactulose, L-carnitine, alpha-lipoic acid and combination of L-carnitine and alpha-lipoic acid in a rat model of acute hepatic encephalopathy: Biochemical observations

Saeed¹,

Ahmed²,

Saleh³

et al. 2017

Trop. J. Pharm Res

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Section: Discussionsupporting

confidence: 94%

Curative role of lactulose, L-carnitine, alpha-lipoic acid and combination of L-carnitine and alpha-lipoic acid in a rat model of acute hepatic encephalopathy: Biochemical observations

Saeed¹,

Ahmed²,

Saleh³

et al. 2017

Trop. J. Pharm Res

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“…It was shown in an open-label study that lactulose can prevent development of the first episode of overt HE but the study needs to be replicated in a larger study in a blinded fashion before firm recommendations can be made [108]. Studies using lactulose and rifaximin have shown improvement in quality of life [109,110] and also in driving simulator performance [111,112]. Probiotics have also been used but the open-label nature, varying amounts and types of organisms and different outcomes make them difficult to recommend as therapeutic options at this time [113–115].…”

Section: Treatmentmentioning

confidence: 99%

Hepatic encephalopathy

Ferenci

2017

Gastroenterology Report

130

104

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Hepatic encephalopathy (HE) is a reversible syndrome of impaired brain function occurring in patients with advanced liver diseases. The precise pathophysiology of HE is still under discussion; the leading hypothesis focus on the role of neurotoxins, impaired neurotransmission due to metabolic changes in liver failure, changes in brain energy metabolism, systemic inflammatory response and alterations of the blood brain barrier. HE produces a wide spectrum of nonspecific neurological and psychiatric manifestations. Minimal HE is diagnosed by abnormal psychometric tests. Clinically overt HE includes personality changes, alterations in consciousness progressive disorientation in time and space, somnolence, stupor and, finally, coma. Except for clinical studies, no specific tests are required for diagnosis. HE is classified according to the underlying disease, the severity of manifestations, its time course and the existence of precipitating factors. Treatment of overt HE includes supportive therapies, treatment of precipitating factors, lactulose and/or rifaximin. Routine treatment for minimal HE is only recommended for selected patients.

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“…All agents shown to be effective for overt HE have also been shown to be effective for covert HE, with the addition of carnitine and acylcarnitine …”

Section: Covert Hepatic Encephalopathymentioning

confidence: 99%

“…All agents shown to be effective for overt HE have also been shown to be effective for covert HE, 67,71,72 with the addition of carnitine and acylcarnitine. 73,74 A low-cost and ecological strategy is summarised in Figure 2.…”

Section: Covert Hepati C En Cephalopathymentioning

confidence: 99%

Hepatic encephalopathy: Diagnosis and management

Amodio

2018

Liver International

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Hepatic encephalopathy (HE) is a peculiar kind of brain dysfunction caused by liver insufficiency and/or portal-systemic shunting. It is related to gut-derived substances. It is a relevant cause of morbidity and hospitalisation for patients with cirrhosis. The prognosis of HE is important in terms of survival and re-hospitalisation. It is related to impaired quality of life, falls and poor driving; presents a relevant burden for caregivers and health services; and may negatively impact on patient's job and income. Proper diagnosis and classification are expected to improve HE management. Once diagnosed, the management and therapeutic options for HE are generally clear. The improvement of knowledge in recent years has also clarified which are the further aims of research in this field of medicine. Prophylaxis of overt HE should always be performed, and this is generally secondary prophylaxis. Primary prophylaxis should be done immediately after upper gastrointestinal bleeding. Great advances in the detection and treatment of mild forms of HE are expected to lead to further improvement in patient management.

show abstract

Rifaximin vs. lactulose in treatment of minimal hepatic encephalopathy

Abstract: Non-inferiority of rifaximin over lactulose for MHE reversal was not established.

Cited by 53 publications

References 28 publications

Curative role of lactulose, L-carnitine, alpha-lipoic acid and combination of L-carnitine and alpha-lipoic acid in a rat model of acute hepatic encephalopathy: Biochemical observations

Curative role of lactulose, L-carnitine, alpha-lipoic acid and combination of L-carnitine and alpha-lipoic acid in a rat model of acute hepatic encephalopathy: Biochemical observations

Hepatic encephalopathy

Hepatic encephalopathy: Diagnosis and management

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