Polyethylene Glycol for Hepatic Encephalopathy

Doran, Amy; Shah, Neeral L.

doi:10.1001/jamainternmed.2014.3501

Cited by 3 publications

(2 citation statements)

References 8 publications

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“…The conclusions suggested that PEG may be superior to standard lactulose therapy in patients with type C overt HE, but further long-term studies are needed. 31 , 32 …”

Section: Hepatic Encephalopathymentioning

confidence: 99%

Management options in decompensated cirrhosis

Shah¹,

Banaei²,

Hojnowski³

et al. 2015

HMER

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Chronic injury to the liver from a variety of different sources can result in irreversible scarring of the liver, known as cirrhosis. Cirrhosis is a major cause of morbidity and mortality in the USA, and according to the Centers for Disease Control and Prevention was responsible for 31,903 deaths in 2010 alone. It is thus of the utmost importance to appropriately manage these patients in the inpatient and outpatient setting to improve morbidity and mortality. In this review, we address four major areas of cirrhosis management: outpatient management of portal hypertension with decompensation, hepatic encephalopathy, hepatorenal syndrome, and bleeding/coagulation issues. Outpatient management covers recommendations for health care maintenance and screening. Hepatic encephalopathy encompasses a brief review of pathophysiology, treatment in the acute setting, and long-term prevention. Hepatorenal syndrome is discussed in regards to pathophysiology and treatment in the hospital setting. Finally, a discussion of the assessment of coagulation profiles in cirrhosis and recommendations for bleeding and thrombosis complications is included. These topics are not all encompassing with regard to this complicated population, but rather an overview of a few medical problems that are commonly encountered in their care.

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“…The conclusions suggested that PEG may be superior to standard lactulose therapy in patients with type C overt HE, but further long-term studies are needed. 31 , 32 …”

Section: Hepatic Encephalopathymentioning

confidence: 99%

Management options in decompensated cirrhosis

Shah¹,

Banaei²,

Hojnowski³

et al. 2015

HMER

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“…In addition, the median time to resolution of the hepatic encephalopathy was shorter with PEG (one versus two days). 11 A recent meta-analysis found that PEG, in comparison to lactulose, can assist more rapid HE resolution within first 24-hours. Moreover, PEG can reduce overall length of hospitalization with minimum adverse effects among patients of HE with liver cirrhosis.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Efficacy of Lactulose with and without Polyethylene Glycol in the Treatment of Patients with Hepatic Encephalopathy

Tahir¹,

Younus²,

Gul³

et al. 2023

PJMHS

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Objective: To compare the effectiveness of the combination of Lactulose and Polyethylene glycol (PEG) versus Lactulose alone in improving the grade of hepatic encephalopathy (HE) within 24 hours of hospital admission in patients with hepatic encephalopathy due to decompensated liver cirrhosis precipitated by constipation. Study Design: Randomized controlled trial. Place and Duration: The Department of Gastroenterology, Hepatology and GI Endoscopy, Shaheed Zulfiqar Ali Bhutto Medical University, Pakistan Institute of Medical Sciences (PIMS), Islamabad, Pakistan from 07-05-2020 to 06-05-2021. Methodology: One hundred and sixteen patients (58 in each group) of either gender aged 20-70 years having decompensated liver cirrhosis with HE grade 2 to 4 secondary to constipation were enrolled. Patients were randomly and equally divided into either Lactulose and PEG (Group-1) or Lactulose alone (Group-2) by lottery method. West Haven Criteria was used for labeling HE grades at the baseline and after 24 hours of treatment in both study groups. A one-grade improvement in HE after 24 hours of treatment from the baseline was considered as effectiveness of treatment. Results: Treatment was found effective (at least one HE grade improvement) in 43 (74.1%) patients treated with PEG+Lactulose, while it was 32 (55.2%) in patients who were treated with Lactulose alone (p=0.033). When stratified for age and gender, PEG+Lactulose was significantly effective in improving HE grades in younger age group (p=0.007) and males (p=0.040). Practical Implications: Combination treatment with PEG+Lactulose can be a preferred option for improvement in HE grades in comparison to treatment with lactulose alone Conclusions: Combination treatment with PEG+Lactulose was found to be more effective in improving HE grades when compared to treatment with lactulose alone within 24 hours of hospital admission among patients who had decompensated liver cirrhosis precipitated by constipation. Keywords: Constipation, decompensated liver disease, Hepatic encephalopathy, Lactulose, Polyethylene glycol.

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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

Naderian¹,

Akbari²,

Saeedi³

et al. 2017

Middle East J Dig Dis

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BACKGROUND In this clinical trial, polyethylene glycol (PEG) solution was compared with lactulose in the treatment of hepatic encephalopathy in patients with cirrhosis. METHODS This randomized controlled trial was performed on 40 patients in two groups. The patients in the lactulose group received either 20-30 grams of lactulose orally or by a nasogastric tube, or 200 grams of lactulose enema by a rectal tube. The patients in the PEG–lactulose group received the same amount of oral or rectal lactulose, plus 280 grams of PEG in 4 liters of water orally as a single dose in 30-120 minutes. Serial physical examinations, hepatic encephalopathy scoring algorithm (HESA), blood level of ammonia, and serum biochemical studies were used to evaluate the severity of hepatic encephalopathy. RESULTS In comparison with lactulose alone, PEG-lactulose could improve HESA score in 24 hours more effectively (p =0.04). Overall, PEG-lactulose regimen was associated with a decrease in length of hospital stay compared with lactulose treatment (p =0.03) but in subgroup analysis we found that PEG-lactulose regimen could only decrease the length of hospital stay in women significantly (p =0.01). CONCLUSION The use of PEG along with lactulose in comparison with lactulose alone is more effective in the treatment of hepatic encephalopathy in patients with cirrhosis and results in more rapid discharge from hospital.

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Polyethylene Glycol for Hepatic Encephalopathy

Cited by 3 publications

References 8 publications

Management options in decompensated cirrhosis

Management options in decompensated cirrhosis

Comparison of Efficacy of Lactulose with and without Polyethylene Glycol in the Treatment of Patients with Hepatic Encephalopathy

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

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