(2005-Paik)Comparison of Rifaximin and Lactulose for the Treatment of Hepatic EncephalopathyA Prosp.pdf

Yonsei Medical Journal Vol. 46, No. 3, pp. 399 - 407, 2005 Yonsei Med J Vol. 46, No. 3, 2005 Rifaximin has been reported to be effective for the treat- ment of hepatic encephalopathy (HE) in Europe. However, it is unknown whether Rifaximin is effective for the treatment of HE in Koreans, therefore we conducted a open-label pros- pective randomized study to evaluate the efficacy of rifaximin versus lactulose in Korean patients. Fifty-four patients with liver cirrhosis and hepatic encephalopathy were enrolled. Thirty-two patients were randomized to receive rifaximin and 22 to receive lactulose both over a 7-day periods. Before and at the end of treatment, gradation of blood ammonia, flapping tremor, mental status, number connection test (NCT) were performed and estimation of HE indexes determined. Both rifaximin and lactulose were effective in the majority of patients (84.4% and 95.4%, respectively, p=0.315). Blood NH3, flapping tremor, mental status, and NCT was signifi- cantly improved by rifaximin and lactulose, and the post- treatment levels of these measures were similar for the rifaximin and lactulose-treated groups, as was the HE index (rifaximin group (10.0 4.2, p=0.000); lactulose group (11.3 5.0, p=0.000)). One patient treated with rifaximin com- plained of abdominal pain, which was easily controlled. There was no episode of renal function impairment in either treatment group. Rifaximin proved to be as safe and as effec- tive as lactulose for the treatment of Korean patients with hepatic encephalopathy. Key Word: Hepatic encephalopathy, rifaximin, lactulose, liver cirrhosis INTRODUCTION Hepatic encephalopathy (HE) is presented clini- cally as a combination of neuropsychiatric abnor- malities characterized by alterations in mental status, personality, intellectual function, and changes in neuromuscular activity. It is frequently observed in those with both acute liver failure and liver cirrhosis.1 The pathogenesis of the syndrome is complex, but ammonia produ