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

TY - JOUR

T1 - Lactulose, rifaximin or branched chain amino acids for hepatic encephalopathy

T2 - what is the evidence?

AU - Gluud, Lise Lotte

AU - Dam, Gitte

AU - Borre, Mette

AU - Les, Iñigo

AU - Cordoba, Juan

AU - Marchesini, Giulio

AU - Aagaard, Niels Kristian

AU - Vilstrup, Hendrik

PY - 2013/6

Y1 - 2013/6

N2 - 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.

AB - 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.

KW - Amino Acids, Branched-Chain

KW - Anti-Bacterial Agents

KW - Disaccharides

KW - Evidence-Based Medicine

KW - Gastrointestinal Agents

KW - Hepatic Encephalopathy

KW - Humans

KW - Lactulose

KW - Rifamycins

U2 - 10.1007/s11011-012-9372-0

DO - 10.1007/s11011-012-9372-0

M3 - Journal article

C2 - 23275147

SN - 0885-7490

VL - 28

SP - 221

EP - 225

JO - Metabolic Brain Disease

JF - Metabolic Brain Disease

IS - 2

ER -