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