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

Abstract

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

Comparative Effectiveness and Safety of Polyethylene Glycol Electrolyte Solution Versus Lactulose for Treatment of Hepatic Encephalopathy

“…All the trials were designed in parallel groups and described as randomized. The generation of allocation sequences was adequately described; treatment allocation was fully hidden in 6 trials [10][11][12][14][15][16] ; single blinding was reported in 5 trials 10,11,[14][15][16] ; assessment of blinded outcomes was conducted in 2 trials. 10,14 The 6 trials were classified as high quality.…”

Polyethylene glycol versus lactulose in the treatment of hepatic encephalopathy: a systematic review and meta-analysis

“…Finally, only four RCTs met our inclusion criteria and were included in the qualitative and quantitative analysis. [12][13][14][15] The baseline characteristics of the included studies are depicted in table 1. Overall, there were a total of 229 patients (121 and 108 patients received PEG and lactulose, respectively).…”

“…Several randomised controlled trials (RCTs) evaluated the effectiveness of PEG versus lactulose in the treatment of HE; however, the results were inconsistent. [12][13][14][15] Herein, we conducted a systematic review and meta-analysis to assess the safety and clinical efficacy of PEG compared with the standard of care lactulose in patients with HE.…”

Novel Drugs for the Management of Hepatic Encephalopathy: Still a Long Journey to Travel

“…Two Indian randomized control trials reported significant improvement of HESA score in the PEG group when compared to lactulose. 86,87 Currently, two trials are under process to access the therapeutic use of PEG in HE. 88,89 Nitazoxanide Nitazoxanide (NTZ) is a broad-spectrum thiazolide antiparasitic agent which has action against many anaerobic bacteria, protozoa, and helminthic species.…”