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COMPARISON OF RIFAXIMIN PLUS LACTULOSE WITH THE LACTULOSE ALONE FOR THE TREATMENT OF HEPATIC ENCEPHALOPATHY

Dr Irfan Shabbir, Dr Rida mazhar, Dr Zubia Rafique

Hepatic encephalopathy is a stimulating complication of liver dysfunction. Therapeutic options for hepatic encephalopathy are currently limited and present significant risks and benefits associated with its use. Rifaximin is a new antimicrobial agent with a broad spectrum of activity that has shown promising results as an alternative option for liver encephalopathy. Objectives and Objectives: The present study was conducted in Mayo Hospital Lahore to compare the efficacy of rifaximin and lactulose as a combination against lactulose alone, to compare adverse effects and to study the rate of therapeutic effects of rifaximin and lactulose.Methods: it was a prospective observational study. 60 patients with hepatic encephalopathy (HE) have been studied. The patients were studied and treated according to the decision of the attending physician. At the time of the analysis, the patients were divided into 2 groups, the rifaximin group that received Rifaximin + Lactulose (R + L) and the Lactulose (L) group, which received only Lactulose. Parameters such as the degree of mental state, the degree of asterixis, the degree of serum ammonia, the degree of test for the numerical connection (NCT degree), the hepatic encephalopathy index (HE index) were assessed and compared in both groups. Clinical efficacy was determined using the HE index improvement. The primary endpoints were decreasing the HE index and reversing the HE ratings. Secondary endpoints were mortality from HE or any other cause, decreased mental status, asterixis grade, serum ammonia grade, NCT grade.Results: Of 60 patients, 32 received a combination of rifaximin + lactulose and 28 patients received lactulose only. The average Child-Turcotte-Pugh score (CTP score) was 10.6 in the R + L group and 10.32 in the L group. There was a statistically significant improvement in the degree of mental state, asterixis degree, serum ammonia degree , NCT grade, hepatic encephalopathy index in both groups, p-value <0.05, but there was no statistically significant difference between improved mental state grade, asterixis grade, serum ammonia grade, NCT grade, HE index between the two groups. Rifaximin the combination of lactulose was effective in 31 out of 32, i.e. 96.87% and lactulose alone in 24 out of 28 patients, or 85.71%, which is not statistically different, p = 0.3251.Discussion: the combination of rifaximin + lactulose is not superior to lactulose alone in the treatment of refractory liver encephalopathy. The addition of rifaximin may aid in the treatment of refractory liver encephalopathyConclusion: the combination of rifaximin + lactulose is effective, but not superior to lactulose alone in the treatment of hepatic encephalopathy.

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