Rifaximin versus Nonabsorbable Disaccharides for the
Treatment of Hepatic Encephalopathy: A Meta-Analysis
Hepatic encephalopathy (HE) is a complex and reversible neuropsychiatric syndrome that results from acute or chronic liver diseases, such as hepatic cirrhosis, alcoholic liver disease . HE is an important complication of hepatic cirrhosis and is an independent predictor of mortality in patients with cirrhosis . HE occurs in the presence of insufficient hepatic clearance of toxins absorbed from the intestine resulting in neurochemical abnormalities across the blood brain barrier . The symptoms of HE, manifested on a continuum, are deterioration in mental status, with psychomotor dys- function, impaired memory, increased reaction time, sen- sory abnormalities, poor concentration, disorientation, even coma, and death [4, 5]. Overt HE means high mortality and poor prognosis. 1-year mortality for patients with severe HE in ICU is 54% . Episodes of overt HE result in fre- quent hospitalizations and pose a formidable burden on the healthcare system, especially in China, a developing country with 100000000 hepatitis B carriers .
Diagnosis of overt hepatic encephalopathy should be made after the exclusion of other brain disorders and based on two types of symptoms.Impaired mental status, as defined by the Conn score, with higher scores indicating more severe impairment, and impaired neuromotor func- tion includes hyperreflexia, rigidity, myoclonus, and asterixi [9, 10]. Minimal hepatic encephalopathy (MHE) that may has no clinical manifestations could be detected only by neuropsychological methods include portosystemic ence- phalopathy (PSE) syndrome test, Psychometric-Hepatic- Encephalopathy-Sum- (PHES-) Score . Elevated serum ammonia level is an effective index of HE and is detected in 60%–80% of affected patients, but a single ammonia levelin the diagnosis of HE is uncertain given the substantial overlap of ammonia levels in both patients with and without encephalopathy . Current treatment strategies include measures aimed at reducing the serum level of ammonia, pro- viding specialized nursing care as well as correcting precipi- tating factors such as gastrointestinal hemorrhage, infection, constipation, and electrolyte disturbances .
download complete article