Cargando…

Long-term management of hepatic encephalopathy with lactulose and/or rifaximin: a review of the evidence

A consolidated overview of evidence for the effectiveness and safety/tolerability of hepatic encephalopathy (HE) treatment over the long term is currently lacking. We identified and assessed published evidence for the long-term (≥6 months) pharmacological management of HE with lactulose and/or rifax...

Descripción completa

Detalles Bibliográficos
Autores principales: Hudson, Mark, Schuchmann, Marcus
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams And Wilkins 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6416096/
https://www.ncbi.nlm.nih.gov/pubmed/30444745
http://dx.doi.org/10.1097/MEG.0000000000001311
_version_ 1783403281269129216
author Hudson, Mark
Schuchmann, Marcus
author_facet Hudson, Mark
Schuchmann, Marcus
author_sort Hudson, Mark
collection PubMed
description A consolidated overview of evidence for the effectiveness and safety/tolerability of hepatic encephalopathy (HE) treatment over the long term is currently lacking. We identified and assessed published evidence for the long-term (≥6 months) pharmacological management of HE with lactulose and/or rifaximin. A literature search was conducted in PubMed (cutoff date 05 March 2018) using the search terms ‘hepatic encephalopathy+rifaximin’ and ‘hepatic encephalopathy+lactulose’. All articles containing primary clinical data were manually assessed to identify studies in which long-term (≥6 months) effectiveness and/or safety/tolerability end points were reported for lactulose and/or rifaximin. Long-term effectiveness outcomes were reported in eight articles for treatment with lactulose alone and 19 articles for treatment with rifaximin, alone or in combination with lactulose. Long-term safety/tolerability outcomes were reported in six articles for treatment with lactulose alone and nine articles for treatment with rifaximin, alone or in combination with lactulose. These studies showed that lactulose is effective for the prevention of overt HE recurrence over the long term and that the addition of rifaximin to lactulose significantly reduces the risk of overt HE recurrence and HE-related hospitalization, compared with lactulose therapy alone, without compromising tolerability. Current evidence therefore supports recommendations for the use of lactulose therapy for the prevention of overt HE recurrence over the long term, and for the additional benefit of adding rifaximin to lactulose therapy. Addition of rifaximin to standard lactulose therapy may result in substantial reductions in healthcare resource utilization over the long term, by reducing overt HE recurrence and associated rehospitalization.
format Online
Article
Text
id pubmed-6416096
institution National Center for Biotechnology Information
language English
publishDate 2019
publisher Lippincott Williams And Wilkins
record_format MEDLINE/PubMed
spelling pubmed-64160962019-03-16 Long-term management of hepatic encephalopathy with lactulose and/or rifaximin: a review of the evidence Hudson, Mark Schuchmann, Marcus Eur J Gastroenterol Hepatol Review Articles A consolidated overview of evidence for the effectiveness and safety/tolerability of hepatic encephalopathy (HE) treatment over the long term is currently lacking. We identified and assessed published evidence for the long-term (≥6 months) pharmacological management of HE with lactulose and/or rifaximin. A literature search was conducted in PubMed (cutoff date 05 March 2018) using the search terms ‘hepatic encephalopathy+rifaximin’ and ‘hepatic encephalopathy+lactulose’. All articles containing primary clinical data were manually assessed to identify studies in which long-term (≥6 months) effectiveness and/or safety/tolerability end points were reported for lactulose and/or rifaximin. Long-term effectiveness outcomes were reported in eight articles for treatment with lactulose alone and 19 articles for treatment with rifaximin, alone or in combination with lactulose. Long-term safety/tolerability outcomes were reported in six articles for treatment with lactulose alone and nine articles for treatment with rifaximin, alone or in combination with lactulose. These studies showed that lactulose is effective for the prevention of overt HE recurrence over the long term and that the addition of rifaximin to lactulose significantly reduces the risk of overt HE recurrence and HE-related hospitalization, compared with lactulose therapy alone, without compromising tolerability. Current evidence therefore supports recommendations for the use of lactulose therapy for the prevention of overt HE recurrence over the long term, and for the additional benefit of adding rifaximin to lactulose therapy. Addition of rifaximin to standard lactulose therapy may result in substantial reductions in healthcare resource utilization over the long term, by reducing overt HE recurrence and associated rehospitalization. Lippincott Williams And Wilkins 2019-04 2018-12-21 /pmc/articles/PMC6416096/ /pubmed/30444745 http://dx.doi.org/10.1097/MEG.0000000000001311 Text en Copyright © 2018 The Author(s). Published by Wolters Kluwer Health, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/) (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0/
spellingShingle Review Articles
Hudson, Mark
Schuchmann, Marcus
Long-term management of hepatic encephalopathy with lactulose and/or rifaximin: a review of the evidence
title Long-term management of hepatic encephalopathy with lactulose and/or rifaximin: a review of the evidence
title_full Long-term management of hepatic encephalopathy with lactulose and/or rifaximin: a review of the evidence
title_fullStr Long-term management of hepatic encephalopathy with lactulose and/or rifaximin: a review of the evidence
title_full_unstemmed Long-term management of hepatic encephalopathy with lactulose and/or rifaximin: a review of the evidence
title_short Long-term management of hepatic encephalopathy with lactulose and/or rifaximin: a review of the evidence
title_sort long-term management of hepatic encephalopathy with lactulose and/or rifaximin: a review of the evidence
topic Review Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6416096/
https://www.ncbi.nlm.nih.gov/pubmed/30444745
http://dx.doi.org/10.1097/MEG.0000000000001311
work_keys_str_mv AT hudsonmark longtermmanagementofhepaticencephalopathywithlactuloseandorrifaximinareviewoftheevidence
AT schuchmannmarcus longtermmanagementofhepaticencephalopathywithlactuloseandorrifaximinareviewoftheevidence