Metabolic Brain Disease

, Volume 28, Issue 2, pp 221–225 | Cite as

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

  • Lise Lotte Gluud
  • Gitte Dam
  • Mette Borre
  • Iñigo Les
  • Juan Cordoba
  • Giulio Marchesini
  • Niels Kristian Aagaard
  • Hendrik Vilstrup
Original Paper

Abstract

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.

Keywords

Cirrhosis Meta-analysis Systematic Review Randomized controlled trials 

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Copyright information

© Springer Science+Business Media New York 2012

Authors and Affiliations

  • Lise Lotte Gluud
    • 1
  • Gitte Dam
    • 2
  • Mette Borre
    • 2
  • Iñigo Les
    • 3
  • Juan Cordoba
    • 3
  • Giulio Marchesini
    • 4
  • Niels Kristian Aagaard
    • 2
  • Hendrik Vilstrup
    • 2
  1. 1.Department of MedicineCopenhagen University Hospital GentofteHellerupDenmark
  2. 2.Department of Medicine V (Hepatology and Gastroenterology)Aarhus University HospitalAarhus CDenmark
  3. 3.Servei de Medicina Interna-Hepatologia, Hospital Vall d’HebronBarcelonaSpain
  4. 4.Department of Internal Medicine, Alma Mater Studiorum, University of BolognaBolognaItaly

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