Polyethylene Glycol Versus Lactulose in the Treatment of Hepatic Encephalopathy: a Systematic Review and Meta-analysis

Overview

Journal BMJ Open Gastroenterol

Specialty Gastroenterology

Date 2021 May 19

PMID 34006606

Citations 3

Authors

Gilles Jadd Hoilat

Mohamad Fekredeen Ayas

Judie Noemie Hoilat

Ahmed Abu-Zaid

Ceren Durer

Seren Durer

Talal Adhami

Savio John

Affiliations

Soon will be listed here.

Abstract

Background: Hepatic encephalopathy (HE) is defined as brain dysfunction that occurs because of acute liver failure or liver cirrhosis and is associated with significant morbidity and mortality. Lactulose is the standard of care till this date; however, polyethylene glycol (PEG) has gained the attention of multiple investigators.

Methods: We screened five databases namely PubMed, Scopus, Web of Science, Cochrane Library and Embase from inception to 10 February 2021. Dichotomous and continuous data were analysed using the Mantel-Haenszel and inverse variance methods, respectively, which yielded a meta-analysis comparing PEG versus lactulose in the treatment of HE.

Results: Four trials with 229 patients were included. Compared with lactulose, the pooled effect size demonstrated a significantly lower average HE Scoring Algorithm (HESA) Score at 24 hours (Mean difference (MD)=-0.68, 95% CI (-1.05 to -0.31), p<0.001), a higher proportion of patients with reduction of HESA Score by ≥1 grade at 24 hours (risk ratio (RR)=1.40, 95% CI (1.17 to 1.67), p<0.001), a higher proportion of patients with a HESA Score of grade 0 at 24 hours (RR=4.33, 95% CI (2.27 to 8.28), p<0.0010) and a shorter time to resolution of HE group (MD=-1.45, 95% CI (-1.72 to -1.18), p<0.001) in favour of patients treated with PEG.

Conclusion: PEG leads to a higher drop in the HESA Score and thus leads to a faster resolution of HE compared with lactulose.

Citing Articles

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Effect of care intervention based on susceptible pointers of care quality in patients with hepatic cerebropathy.

Chen L, Rao S, Fan S, Pan C, Liu M, Yi L Am J Transl Res. 2022; 14(6):4082-4089.

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New Therapies of Liver Diseases: Hepatic Encephalopathy.

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