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Lactulose, rifaximin or branched chain amino acids for hepatic encephalopathy: what is the evidence?

Metabolic brain disease (2013-01-01)
Lise Lotte Gluud, Gitte Dam, Mette Borre, Iñigo Les, Juan Cordoba, Giulio Marchesini, Niels Kristian Aagaard, Hendrik Vilstrup
RÉSUMÉ

Hepatic encephalopathy (HE) is a serious complication of acute and chronic liver disease associated with severe morbidity and mortality. We performed updated random effects meta-analyses to evaluate the evidence for non-absorbable disaccharides (lactulose and lactitol), rifaximin and branched chain amino acids (BCAA). A meta-analysis of randomized trials showed that, compared with placebo or no intervention, non-absorbable disaccharides have beneficial effects on HE manifestations and prevention of HE episodes. The addition of rifaximin to non-absorbable disaccharides versus rifaximin alone was more beneficial than non-absorbable disaccharides used alone on both outcome measures. Likewise, a meta-analysis of randomised controlled trials found that oral BCAA supplements have beneficial effects on manifestations of HE compared with control supplements. The effect was found in a variety of clinical settings. No convincing effects of intravenous BCAA for episodic HE were identified. In conclusion, evidence-based treatment recommendations for patients with HE should include non-absorbable disaccharides combined with rifaximin or BCAA. Additional evidence is needed to evaluate the effect of combining all three interventions.

MATÉRIAUX
Référence du produit
Marque
Description du produit

Sigma-Aldrich
Lactulose, ≥98.0% (HPLC)
Sigma-Aldrich
Lactulose, ≥95% (HPLC)
Sigma-Aldrich
Rifaximin
USP
Lactulose, United States Pharmacopeia (USP) Reference Standard
Rifaximin, European Pharmacopoeia (EP) Reference Standard
Lactulose, European Pharmacopoeia (EP) Reference Standard
Rifaximin for system suitability, European Pharmacopoeia (EP) Reference Standard
Lactulose for peak identification, European Pharmacopoeia (EP) Reference Standard
Supelco
Rifaximin, VETRANAL®, analytical standard