Comparison of Dual Therapy, Rifaximin plus Lactulose with Monothrapy, Lactulose Alone in the Treatment of Portosystemic Encephalopathy

Authors

  • Hyder Wajid Abbasi, Mashood Ali, Irfan Younus, Furqan Tahir, Adnan Qadir, Talha Firoz

DOI:

https://doi.org/10.53350/pjmhs2023175222

Abstract

Objective: To compare the efficacy of dual therapy (rifaximin and lactulose) and lactulose monotherapy in the treatment of porto-systemic encephalopathy.

Study Design: Randomized control trial.

Place and Duration of Study: Department of Gastroenterology, PIMS Hospital, Islamabad from 1st July 2020 to 31st December 2020.

Methodology: One hundred and fifty patients of both genders age ranges from 18-65 years with liver cirrhosis having hepatic encephalopathy grade II or above were included. They were divided in two groups; each group comprised 75 patients. Group A took lactulose and rifaximin, while lactulose alone was given to Group B. All patients were monitored for 5 days on the basis of Child Pugh Criteria.

Results: The mean age was 40.02+24.4 years. One hundred twenty six (85.1%) of patients were above 50 years. Males were 60%, majority of patients were from the emergency department, while 17 were from OPD. HCV was identified as the major cause of cirrhosis (72.6%), while HBV (14.6%), alcohol (4%) and others (8.6%) contributed nominally. Constipation was major precipitating factor in 83 patients while sepsis and UGI Bleed was culprit in 31 and 19 patients respectively. Sixty patients (80%) of group A of both genders showed improvement in five days, while 42 patients (56%) of group B showed improvement in the same period of time (p=0.006). It was found more in males and elder patients.

Practical implication: Dual therapy will reduce the morbidity, hospital stay and cost of treatment. It may also help in making local guidelines for treatment of hepatic encephalopathy.

Conclusion: Rifaximin plus lactulose therapy was far superior to lactulose monotherapy in every age group and either gender.

Keywords: Porto systemic encephalopathy, Decompensated chronic liver disease, Rifaximin lactulose therapy, Lactulose monotherapy

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How to Cite

Hyder Wajid Abbasi, Mashood Ali, Irfan Younus, Furqan Tahir, Adnan Qadir, Talha Firoz. (2023). Comparison of Dual Therapy, Rifaximin plus Lactulose with Monothrapy, Lactulose Alone in the Treatment of Portosystemic Encephalopathy. Pakistan Journal of Medical & Health Sciences, 17(05), 222. https://doi.org/10.53350/pjmhs2023175222