Article
Health Care Sciences & Services
Ching Chang, Chien-Hao Huang, Hsiao-Jung Tseng, Fang-Chen Yang, Rong-Nan Chien
Summary: This study evaluated the one-year efficacy of rifaximin add-on to lactulose for the maintenance of HE remission, showing significant improvement in HE remission maintenance and reduction in HE-related hospitalizations in the rifaximin add-on group compared to lactulose alone. Long-term use of rifaximin add-on to lactulose was found to be effective in reducing HE recurrence and related hospitalization for patients with decompensated cirrhosis.
JOURNAL OF PERSONALIZED MEDICINE
(2021)
Article
Gastroenterology & Hepatology
Rajiv Jalan, Christopher F. Rose
Summary: The clinical progress in managing hepatic encephalopathy lags behind basic research, making current criteria for definition, classification, diagnosis, and grading difficult to apply reproducibly. Studies suggest that hepatic encephalopathy may be irreversible in many patients, requiring further research into neuronal injury and death mechanisms for future drug development. Lactulose, currently considered the standard of care, has poor clinical evidence for all severity levels of hepatic encephalopathy, and ethical consideration should be given to placebo-controlled trials.
JOURNAL OF HEPATOLOGY
(2022)
Article
Gastroenterology & Hepatology
Marika Rudler, Virginia Hernandez-Gea, Bogdan Dumitru Procopet, Alvaro Giraldez, Lucio Amitrano, Candid Villanueva, Luis Ibanez, Gilberto Silva-Junior, Joan Genesca, Christophe Bureau, Jonel Trebicka, Rafael Banares, Aleksander Krag, Elba Llop, Wim Laleman, Jose Maria Palazon, Jose Castellote, Susana Rodrigues, Lise Lotte Gluud, Carlos Noronha Ferreira, Nouria Canete, Manuel Rodriguez, Arnulf Ferlitsch, Jose Luis Mundi, Henning Gronbaek, Manuel Hernandez-Guerra, Romano Sassatelli, Alessandra Dell'era, Marco Senzolo, Juan G. Abraldes, Manuel Romero-Gomez, Alexander Zipprich, Meritxell Casas, Helena Masnou, Helene Larrue, Massimo Primignani, Frederik Nevens, Jose Luis Calleja, Remy Schwarzer, Christian Jansen, Marie-Angele Robic, Irene Conejo, Javier Martinez Gonzalez, Maria Vega Catalina, Agustin Albillos, Edilmar Alvarado, Maria Anna Guardascione, Maxime Mallet, Simona Tripon, Georgina Casanovas, Jaume Bosch, Juan-Carlos Garcia-Pagan, Dominique Thabut
Summary: pTIPS is more effective in improving survival compared to endoscopic treatment for high-risk patients with cirrhosis and variceal bleeding. HE at admission does not affect the efficacy of pTIPS.
Article
Medicine, General & Internal
Yuka Hayakawa, Nobuharu Tamaki, Hiroyuki Nakanishi, Masayuki Kurosaki, Yuki Tanaka, Kento Inada, Shun Ishido, Sakura Kirino, Koji Yamashita, Tsubasa Nobusawa, Hiroaki Matsumoto, Tatsuya Kakegawa, Mayu Higuchi, Kenta Takaura, Shohei Tanaka, Chiaki Maeyashiki, Shun Kaneko, Yutaka Yasui, Yuka Takahashi, Kaoru Tsuchiya, Ryuichi Okamoto, Namiki Izumi
Summary: This study investigated the change in hospitalization rate before and after rifaximin add-on therapy in lactulose resistant patients with hepatic encephalopathy. The findings showed that rifaximin administration significantly reduced the hospitalization rate and ammonia levels among treatment-resistant patients, suggesting that rifaximin can be used as an add-on treatment for hepatic encephalopathy.
Review
Gastroenterology & Hepatology
Patricia P. Bloom, Elliot B. Tapper, Vincent B. Young, Anna S. Lok
Summary: Hepatic encephalopathy (HE) is a complication of cirrhosis characterized by neuropsychiatric and motor dysfunction, with microbiota-host interactions playing a crucial role in its pathogenesis. Microbiome-targeted therapies, such as prebiotics, probiotics, and fecal microbiota transplant (FMT), have shown some success in treating HE by altering the microbial community composition and function. However, challenges remain in the effective application of microbiome therapeutics, including the resilience of the microbiome to sustainable change and unpredictable clinical outcomes. Future research should focus on rigorous trial design, therapy selection, and a personalized approach to HE.
JOURNAL OF HEPATOLOGY
(2021)
Article
Pharmacology & Pharmacy
Megan Kunka Fritz, Anthony A. Mangino, Taylor V. Hunt, C. Tyler Pitcock, Adam J. Dugan, Kishore Karri, Pradeep Yarra
Summary: This study is the first to evaluate the use of zinc for hepatic encephalopathy treatment in the United States. The results show that zinc does not impact the 30-day and 1-year all-cause readmission rates in patients. Further research is needed to assess the potential benefits of zinc for hepatic encephalopathy treatment.
ANNALS OF PHARMACOTHERAPY
(2023)
Article
Gastroenterology & Hepatology
Elliot B. Tapper, Utibe R. Essien, Zhe Zhao, Nneka N. Ufere, Neehar D. Parikh
Summary: This study found that compared to White patients, Black and Hispanic patients are less likely to be prescribed rifaximin, receive fewer refills, spend more, and have less access to specialists familiar with rifaximin. Efforts to address cost and access may help reduce these disparities.
JOURNAL OF HEPATOLOGY
(2022)
Article
Gastroenterology & Hepatology
Jasmohan S. Bajaj, Tarek I. Hassanein, Nikolaos T. Pyrsopoulos, Arun J. Sanyal, Robert S. Rahimi, Zeev Heimanson, Robert J. Israel, Don C. Rockey
Summary: Two clinical trials were conducted to evaluate dosing of Rifaximin SSD for the treatment of cirrhosis-related complications. The results showed that the immediate-release tablets of 40mg may reduce hospitalizations in patients with cirrhosis and shorten the duration of overt hepatic encephalopathy during hospitalization.
CLINICAL GASTROENTEROLOGY AND HEPATOLOGY
(2023)
Article
Gastroenterology & Hepatology
Attapon Rattanasupar, Arunchai Chang, Keerati Akarapatima, Thanongsak Chaojin, Teerha Piratvisuth
Summary: The study showed that a five-day course of lactulose was not effective in preventing hepatic encephalopathy in cirrhotic patients with acute upper gastrointestinal bleeding. In addition, increased baseline CTP score and presence of diarrhea were found to be independent risk factors for the development of hepatic encephalopathy.
INDIAN JOURNAL OF GASTROENTEROLOGY
(2021)
Review
Gastroenterology & Hepatology
Catherine T. Frenette, Cynthia Levy, Sammy Saab
Summary: Cirrhosis is a serious illness with complications like hepatic encephalopathy (HE) leading to poor outcomes such as hospital readmission, decreased quality of life, and increased mortality. Guidelines recommend lactulose as first-line therapy for HE and a combination of lactulose and rifaximin to reduce the risk of HE recurrence. Approaches to improve management and prevention of HE, including adjusting medication dosages correctly and incorporating supportive care initiatives, can improve post-discharge outcomes.
DIGESTIVE DISEASES AND SCIENCES
(2022)
Article
Gastroenterology & Hepatology
Kenneth W. Chow, Brittney M. Ibrahim, Jung J. Yum, An Dang, Long Dang, Kuan-Ting Chen, Nicholas J. Jackson, Sammy Saab
Summary: This study aimed to identify the factors contributing to lactulose non-adherence and propose strategies for promoting greater adherence. Findings showed that barriers to adherence included large volumes of lactulose, high frequency of dosing, difficulty remembering medication intake, unpleasant taste, and medication side-effects. Most patients understood the importance of lactulose and felt that it was effective in managing hepatic encephalopathy. Rating: 8/10.
DIGESTIVE DISEASES AND SCIENCES
(2023)
Article
Gastroenterology & Hepatology
Masayuki Ueno, Takashi Fujiwara, Hironobu Tokumasu, Toshifumi Mano, Takahisa Kayahara, Hiroyuki Takabatake, Youichi Morimoto, Kazuhiro Matsueda, Toshio Fukuoka, Motowo Mizuno
Summary: This study investigated the real-world adherence and effectiveness of antibiotic prophylaxis in cirrhotic patients with upper gastrointestinal bleeding (UGIB) in Japan. The study found that under current circumstances, only 11.5% of cirrhotic patients received antibiotic prophylaxis, and it was not associated with better clinical outcomes.
JOURNAL OF GASTROENTEROLOGY
(2023)
Article
Gastroenterology & Hepatology
Peter Lykke Eriksen, Lars Djernes, Hendrik Vilstrup, Peter Ott
Summary: This study aimed to quantify whole-body ammonia metabolism in healthy persons and patients with cirrhosis, and validate the effects of glycerol phenylbutyrate and lactulose + rifaximin treatment. The results showed that patients with cirrhosis had lower ammonia clearance and higher ammonia production, and glycerol phenylbutyrate increased clearance while lactulose + rifaximin reduced production.
JOURNAL OF HEPATOLOGY
(2023)
Review
Medicine, General & Internal
Junxiong Cheng, Yafang Chen, Wenfu Cao, Guoqing Zuo
Summary: This meta-analysis compared the efficacy of rifaximin and nonabsorbable disaccharides (NADs) in treating hepatic encephalopathy. Rifaximin was found to be better in achieving complete resolution of HE compared to NADs, but no significant differences were observed in mental status, blood ammonia level, or adverse effects between the two treatment groups.
Review
Medicine, General & Internal
Piero Amodio, Sara Montagnese
Summary: Hepatic encephalopathy is a form of brain dysfunction caused by liver insufficiency and/or portal-systemic shunting, with inconsistencies in its detection and management. Diagnosis of HE involves consideration of its phenotypes, risk factors, and differential diagnosis from other similar conditions.
JOURNAL OF CLINICAL MEDICINE
(2021)