Comparative Effectiveness of Different Treatment Regimens with Rifaximin-α in Patients with Minimal Hepatic Encephalopathy and Liver Cirrhosis (Analysis of 6-Month Follow-Up)

Abstract

Minimal hepatic encephalopathy (MHE) is the earliest and mildest form of hepatic encephalopathy (HE), however, its occurrence is associated with an unfavorable prognosis for cirrhosis in patients in this category. MHE increases the number of falls, injuries, patients getting into road traffic accidents, and accidents, which has serious consequences for the quality of life, and also affects the increase in the frequency of hospitalizations and mortality in patients in this category. Timely correction of cognitive impairment is the key to treating and reversing MHE, as well as improving the quality of life in patients with cirrhosis. Objectives. To study the optimal regimens for the use of rifaximin-α and study its effect on the main clinical and laboratory parameters and quality of life of patients with MHE against the background of cirrhosis during long-term treatment. Material and methods. Inclusion criteria: men and women from 18 to 75 years old; availability of CPU; presence of MHE; signed voluntary informed consent. Non-inclusion criteria: refusal to participate in the study; acute hepatitis; HIV co-infection; severe comorbid pathology; mental illness; Wilson – Konovalov disease. Research methods: clinical examination (analysis of patient complaints, assessment of objective status); laboratory tests (ammonia levels); assessment of the severity of liver disease according to the Child – Pugh scale; assessment of the degree of HE based on the results of psychometric tests (number connection test, animal naming test, brief mental status scale); quality of life questionnaire (SF-36). Results. In the absence of rifaximin-α therapy, there is a deterioration in the quality of life due to a decrease in indicators of the mental component of health, as well as an increase in time in performing the psychometric number connection test. Against the background of continuous and cyclic therapy with rifaximin-α in patients with cirrhosis and MHE during 6 months of observation, the level of capillary blood ammonia decreases. Conclusions. When comparing the effectiveness of continuous and course therapy with rifaximin-α, the results did not show significant differences, which indicates the equivalence of these treatment regimens after 6 months of observations.