olyethylene Glycol and Lactulose versus Lactulose Alone in the Treatment of Hepatic Encephalopathy in Patients with Cirrhosis: A Non-Inferiority Randomized Controlled Trial

Naderian, Mohammadreza; Akbari, Heshmatollah; Saeedi, Morteza; Sohrabpour, Amir Ali

doi:10.15171/mejdd.2016.46

Cited by 38 publications

(71 citation statements)

References 35 publications

(36 reference statements)

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“…Out of 50 patients 39 were males and 11 were females . The male predominant population in this study was likely due to the risk of chronic alcohol use as a cause of chronic liver disease which was consistent with other studies done by Rahimi etal (9), and Naderian et al (10) respectively. .…”

Section: Discussion:-supporting

confidence: 92%

“…Most patients admitted with H.E had more than one precipitating factor . In our study population , the most common precipitant for Hepatic encephalopathy was GI Bleeding, 42 % ( 21/50 ) patients , followed by Constipation , 26% ( 13/50 ) and Sepsis in 18% ( 9/50) patients , which was almost similar to the the study done by Naderian etal (10) . .…”

Section: Discussion:-supporting

confidence: 89%

“…Our study group had advanced age with a Mean age of 62.12 ± 5.93 years in PEG group and 60.48 ± 8.45 years in Lactulose group ( P value = NS ) , as compared to Rahimi etal (9), where mean age was 56 ± 11 in PEG group and 56 ±7 in Lactulose group . In a study done by Naderian et al (10) , the mean age was 53.57± 11.61 yrs in (PEG + Lactulose ) group compared to 59.63 ± 9.27 in Lactulose group alone .…”

Section: Discussion:-mentioning

confidence: 92%

“…. Naderian etal (10) reported Hepatitis B as their main etiological factor for liver cirrhosis in 30% (12/40) , followed by Cryptogenic 27.5% (11/40) , Hepatitis C 22.5% (9/40) and alcohol in 5% (2/40) patients respectively . Reason for this difference was alcohol consumption is very common in our society and easily available .…”

Section: Discussion:-mentioning

confidence: 99%

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To Compare the Effect of Polyethylene Glycol vs Lactulose in the Treatment of Overt Hepatic Encephalopathy.

Raja¹,

Jan²,

Sebastian³

et al. 2019

IJAR

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Inroduction : Hepatic encephalopathy is one of the most common cause of hospitalization for cirrhotic patients.. Lactulose has long been used as the standard therapy for the treatment of acute HE. This study evaluated the efficacy of PEG as compared with lactulose for the initial treatment of HE. Aims & Objective: (1) To compare efficacy of PEG 3350 electrolyte solution over lactulose in patients admitted for hepatic encephalopathy. (2) To determine whether treatment with PEG will reduce duration of hospital stay ,and whether PEG can be an effective additional treatment option for HE. Material & Methods:This Prospective , randomized , Comparative study was conducted in the Department of Gastroenterology Medical Trust hospital , Kochi-Kerala India , over a period of two year from May 2015-April 2017 following its approval by the Institutional ethical committee. 50 patients with cirrhosis and altered mental status attributed to HE were randomized to a standard lactulose protocol or a PEG protocol (25 in each group). Interventions : Patients in the PEG group (n =25) received 2 L of PEG orally or via NG tube as a single dose over 4 hours. Patients in the lactulose group (n=25) received 20-30 g lactulose orally or via NG tube for 3 or more doses over 24 hours, or a single dose of 200 g lactulose via rectal tube. Grade of HE was determined prior to treatment and again at 24 hours using the hepatic encephalopathy scoring algorithm (HESA). After 24 hours, all patients received lactulose per the standard of care. Main Outcomes And Measures : The primary end point was an improvement of 1 or more in HE grade at 24 hours, determined using the hepatic encephalopathy scoring algorithm (HESA), ranging from 0 (normal clinical and neuropsychological assessments) to 4 (coma). Secondary outcomes included time to HE resolution and overall length of stay. Results : In our study , the gender distribution among two study groups showed a male predominant. Majority of HE patients were found in age group of 55-64 years. The most common underlying etiology of Liver Cirrhosis was Alcoholic

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Section: Discussion:-supporting

confidence: 92%

Section: Discussion:-supporting

confidence: 89%

Section: Discussion:-mentioning

confidence: 92%

Section: Discussion:-mentioning

confidence: 99%

See 2 more Smart Citations

To Compare the Effect of Polyethylene Glycol vs Lactulose in the Treatment of Overt Hepatic Encephalopathy.

Raja¹,

Jan²,

Sebastian³

et al. 2019

IJAR

View full text Add to dashboard Cite

show abstract

“…This scoring system ranges from 0 (normal clinical and neuropsychological evaluations) to 4 (coma) . Two of these trials confirmed that PEG administration results in faster resolution of HE compared with lactulose, and the other one proved that the PEG‐lactulose combination is more effective in HE treatment than lactulose only . More details on the trials evaluating the role of PEG in acute HE management are shown in Table .…”

Section: Treatmentmentioning

confidence: 88%

Hepatic Encephalopathy and Nutrition Influences: A Narrative Review

Fallahzadeh

Rahimi

2019

Nut in Clin Prac

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Hepatic encephalopathy (HE) is a potentially reversible neurocognitive condition seen in patients with advanced liver disease. The overt form of HE has been reported in up to 45% of patients with cirrhosis. This debilitating condition is associated with increased morbidity and mortality and imposes a significant burden on the caregivers and healthcare system. After providing an overview of HE epidemiology and pathophysiology, this review focuses on the interaction of HE and frailty, nutrition requirements and recommendations in cirrhotic patients with HE, and current dietary and pharmacologic options for HE treatment. (Nutr Clin Pract. 2020;35:36-48)

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Lactulose vs Polyethylene Glycol for Treatment of Hepatic Encephalopathy

Tapper

2015

JAMA Intern Med

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Introduction: Hepatic Encephalopathy is one of the most common causes of hospitalization for cirrhotic patients.Lactulose has long been used as the standard therapy for the treatment of acute HE. This study evaluated the efficacy of PEG as compared with lactulose for the initial treatment of HE. Aims and Objective:(1) To compare efficacy of PEG 3350 electrolyte solution over lactulose in patients admitted for hepatic encephalopathy. (2) To determine whether treatment with PEG will reduce duration of hospital stay, and whether PEG can be an effective additional treatment option for HE. Material and methods: This prospective, randomized, comparative study was conducted in the Department of Gastroenterology Medical Trust hospital, Kochi-Kerala India, over a period of two year from May 2015-April 2017 following its approval by the Institutional ethical committee. 50 patients with cirrhosis and altered mental status attributed to HE were randomized to a standard lactulose protocol or a PEG protocol (25 in each group). Interventions: Patients in the PEG group (n=25) received 2 L of PEG orally or via NG tube as a single dose over 4 hours. Patients in the lactulose group (n=25) received 20-30 g lactulose orally or via NG tube for 3 or more doses over 24 hours, or a single dose of 200 g lactulose via rectal tube. Grade of HE was determined prior to treatment and again at 24 hours using the Hepatic Encephalopathy Scoring Algorithm (HESA). After 24 hours, all patients received lactulose per the standard of care. Main outcomes and measures: The primary end point was an improvement of 1 or more in HE grade at 24 hours, determined using the Hepatic Encephalopathy Scoring Algorithm (HESA), ranging from 0 (normal clinical and neuropsychological assessments) to 4 (coma). Secondary outcomes included time to HE resolution and overall length of stay. Results: In our study, the gender distribution among two study groups showed a male predominant. Majority of HE patients were found in age group of 55-64 years. The most common underlying etiology of Liver Cirrhosis was Alcoholic liver disease 70%, Cryptogenic 14%, followed by Hepatitis C. The most common precipitant for Hepatic encephalopathy was GI Bleeding, followed by Constipation and Sepsis. The two groups were comparable in terms of baseline laboratory parameters. All patients were of Child Turcot Pugh (CTP) class C, with a Mean MELD score of 19.08 ± 2.23 in PEG group vs. 18.76 ± 2.36 in Lactulose group (p-value=0.625, NS). Majority of the patients were in grade 3 encephalopathy 58% (29/50), followed by grade 2 in 32% (16/50) at the time of presentation. A significant difference was seen between two groups in terms of mean change in grade of encephalopathy (HESA score) after 24 hours of therapy, with 1.00 ± 1.04 in PEG group compared to 1.76 ± 0.87 in lactulose group, with a significant p-Jo u r n a l of Hepat o lo g y an d Ga st ro i n te stin al D is o rd e rs

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olyethylene Glycol and Lactulose versus Lactulose Alone in the Treatment of Hepatic Encephalopathy in Patients with Cirrhosis: A Non-Inferiority Randomized Controlled Trial

Cited by 38 publications

References 35 publications

To Compare the Effect of Polyethylene Glycol vs Lactulose in the Treatment of Overt Hepatic Encephalopathy.

To Compare the Effect of Polyethylene Glycol vs Lactulose in the Treatment of Overt Hepatic Encephalopathy.

Hepatic Encephalopathy and Nutrition Influences: A Narrative Review

Lactulose vs Polyethylene Glycol for Treatment of Hepatic Encephalopathy

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