Role of Rifaximin in Prevention of Recurrent Hepatic Encephalopathy in Chronic Liver Disease
DOI:
https://doi.org/10.51985/JBUMDC2020030Keywords:
End stage liver disease, Hepatic encephalopathy, RifaximinAbstract
Objectives: To determine the efficacy (in terms of recurrence) of rifaximin in Hepatic Encephalopathy (HE) in chronic
liver disease.
Study Design and Setting: A descriptive study carried out from 4th September 2018 to 3rd March 2019 at the
department of Medicine, Combined Military Hospital, Quetta.
Methodology: A total of 104 patients of chronic liver disease with HE, 25-65 years and both genders were included.
Patients with gastrointestinal hemorrhage, chronic renal insufficiency and anemia were excluded. Then tab Rifaximin
550 mg twice daily along with standard prescription i.e. Lactulose 30 to 60 ml in two to three divided doses per
day was given to each patient and efficacy was noted. Statistical analysis was carried out using SPSS version 20.0.
Age, duration of disease and Conn’s score was presented as mean and standard deviation. A p value = 0.05 was
considered as significant
Results: Age range in our study was from 25 to 65 years with a mean of 45.73 ± 8.13 years. Most of the patients
54 (51.92%) were between 46 to 65 years of age range. Out of the 104 patients, 77 (74.04%) were male and male
to female ratio was 2.9:1. Mean duration of disease was 13.66 ± 3.77 months. Mean conn’s score was 4.77 ± 1.43.
Efficacy (no recurrence) of rifaximin in HE in chronic liver disease was found in 85 (81.73%) patients.
Conclusion: It was inferred that rifaximin is useful in decreasing the recurrence of HE in chronic liver disease
patients with previous episode/s of encephalopathy.
References
Shawcross DL, Dunk AA, Jalan R. How to diagnose and manage HE: a consensus statement on roles and responsibilities beyond the liver specialist. Eur J GastroenterolHepatol. 2016;28(2):146-52.
Gluud LL, Dam G, Borre M. Lactulose, rifaximin or branched chain amino acids for HE: what is the evidence.Metab Brain Dis. 2013;28:221-5.
Butterworth RF. Neurosteroids in HE: Novel insights and new therapeutic opportunities. J Steroid BiochemMol Biol. 2016;160:94-7.
Gluud LL, Vilstrup H, Morgan MY. Non-absorbable disaccharides versus placebo/no intervention andlactulose versus lactitol for the prevention and treatment of hepaticencephalopathy in people with cirrhosis (Review). (2016). Cochrane Database of Systematic Reviews, Issue 5. CD003044.
Zullo A, Hassan C, Ridola L, Lorenzetti R, Salvatore MA, Riggio O. Rifaximin therapy and HE: Pros and cons. World J GastrointestPharamcolTher. 2012;3:62-7.
Bass NM, Mullen KD, Sanyal A, Poordad F, Neff G, Leevy CB, et al. Rifaximin Treatment in HE. N Engl J Med. 2010;362:1071-81
Ali B, Zaidi YA, Alam A, Anjum HS. Efficacy of Rifaximin in prevention of recurrence of HE in patients with cirrhosis of liver. J Coll Physicians Surg Pak. 2014;24(4):269-73
Morillas RM, Sala M, Planas R. Hepatic encephalopathy prophylaxis. Med Clin (Barc). 2014; 142: 512–514
Hudson M, Schuchmann M. Long-term management of hepatic encephalopathy with lactulose and/or rifaximin: a review of the evidence. Eur J Gastroenterol Hepatol. 2019;31(4):434
Gluud LL, Dam G, Les I, Marchesini G, Borre M, Aagaard NK, Vilstrup H . Branched-chain amino acids for people with hepatic encephalopathy.Cochrane Database Syst Rev. 2017;5:CD001939. Epub 2017 May 18
Sidhu SS, Sharma BC, Goyal O, Kishore H, Kaur N . L-ornithine L-aspartate in bouts of overt hepatic encephalopathy. Hepatology. 2018;67(2):700. Epub 2017 Dec 2
Maharshi S, Sharma BC, Sachdeva S, Srivastava S, Sharma P. Efficacy of Nutritional Therapy for Patients With Cirrhosis and Minimal Hepatic Encephalopathy in a Randomized Trial. Clin Gastroenterol Hepatol. 2016;14(3):454
Martí-Carvajal AJ, Gluud C, Arevalo-Rodriguez I, Martí-Amarista CE. Acetyl-L-carnitine for patients with hepatic encephalopathy. Cochrane Database Syst Rev. 2019;1:CD011451
Goh ET, Andersen ML, Morgan MY, Gluud LL. Flumazenil versus placebo or no intervention for people with cirrhosis and hepatic encephalopathy. Cochrane Database Syst Rev. 2017;7:CD002798. Epub 2017 Jul 26
Dalal R, McGee RG, Riordan SM, Webster AC. Probiotics for people with hepatic encephalopathy. Cochrane Database Syst Rev. 2017;2:CD008716.
Habib H, Nayab D, Hayat Z, Jamil S, Khan H.Evaluation of efficacy of rifaximin in the treatment of hepatic encephalopathy in patients with cirrhosis. Gomal J Med Sci. 2016;14:37-40.
Hussain M, Rehman H, Akhtar L, Ghafoor MB.Hepatic Encephalopathy; To Compare TheEfficay Of Lactulose Alone And Lactulose With Rifaxamin In Patients Of Hepatic Encephalopathy. Professional Med J. 2017;24:947-51.
Ali B, Zaidi YA, Alam A, Anjum HS.Efficacy of Rifaximin in Prevention of Recurrence of HepaticEncephalopathy in Patients with Cirrhosis of Liver. J Coll Physicians Surg Pak Apr 2014;24:269-73.
Debbia EA, Maioli E, Roveta S, Marchese A. Effects of rifaximin on bacterial virulence mechanisms at supra- and sub-inhibitory concentrations. J Chemother 2008;20:186-194
Paik YH, Lee KS, Han KH, et al. Comparison of rifaximin and lactulose for the treatment of HE: a prospective randomized study. Yonsei Med J 2005;46:399-407
Sanyal A, Younossi ZM, Bass NM, et al. Randomised clinical trial: rifaximin improves health-related quality of life in cirrhotic patients with hepatic encephalopathy: a double-blind placebo-controlled study. Aliment Pharmacol Ther 2011;34:853-61
Lawrence KR, Klee JA. Rifaximin for the treatment of HE. Pharmacotherapy. 2008;28:1019–1032.
Bajaj JS, Schubert CM, Heuman DM, Wade JB, Gibson DP, Topaz A et al. Persistence of cognitive impairment after resolution of overt hepatic encephalopathy. Gastroenterology. 2010;138(7):2332
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2021 Sahar Farzand, Abdul Latif Khattak, Rafi ud Din, Karamat Hussain Shah Bukhari, Muhammad Shahbaz Amin, Shahzeb Ahmed Satti
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Journal of Bahria University Medical & Dental College is an open access journal and is licensed under CC BY-NC 4.0. which permits unrestricted non commercial use, distribution and reproduction in any medium, provided the original work is properly cited. To view a copy of this license, visit https://creativecommons.org/licenses/by-nc/4.0