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TO COMPARE THE EFFICACY OF LACTULOSE ALONE AND LACTULOSE WITH RIFAXAMIN IN PATIENTS WITH HEPATIC ENCEPHALOPATHY

Ahmad Zahid, Muhammad Akash, Zauraiz Anjum

Abstract: Objective; To compare the efficacy of lactulsoe alone and in combination with rifaxamin in cases with hepatic encephalopathy. Patients and methods It was a randomized control trail conducted at Al-Nafees Medical college, Islamabad & Sir Ganga Ram Hospital, Lahore during July to December 2018. In this study total 120 cases of liver cirrhosis were identified their encephalopathy was grades according to West Haven’s criteria. The cases with hepatocellular carcinoma, active alcoholics, psychiatric patients and those with encephalopathies due to any other cause and with renal failure were excluded. The cases were then divided into two equal groups with 60 cases in each group. The group A was treated with lactulose alone and B with lactulose plus rifaxamin in their standard doses. The cases were then followed and assessed for their improvement in symptoms and assessed on West Haven’s scale and the cases with complete resolution of symptoms were labeled as cured. The mortality benefit was also noted. Results; In this study there were120 cases out of which 91 had hepatitis C, 20 had hepatitis B while 9 had both B & C. The mean age was 43.24± 8.34 years and mean duration of symptoms was 3.45± 0.8 days. There were 60 cases in each group. Group A had 29 (48.33%) males and 31 (51.67%) females while Group B had 34 (48.33%) males and 26 (51.67%) females. There was no significant difference in terms of child pugh class in both groups with p= 0.69. There was also no significant difference in both groups in terms of grades of encephalopathy (p= 0.21). However there was significant better efficacy and decreased mortality in group B as compared to A with p values of 0.02 and 0.03 respectively. Conclusion; Hepatic encephalopathy is a fatal complication. Lactulose combined with rifaxamin has significant improvement in encephalopathy as well as in reducing mortality. Key words: Hepatic encephalopathy, lactulose, rifaxamin.

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