A Comparative Study to Determine the Outcome of Hepatic Encephalopathy who Have A Past History of Hepatic Encephalopathy And or Upper Gastrointestinal Bleeding Versus Who Have Not Such Using 7 Days Therapy of RifaximinAnd or Lactulose

Abstract

Introduction: Hepatic encephalopathy is a reversible neuro-psychiatric syndrome occurring in majority of patients with decompensated chronic liver disease(CLD). Prognosis of Hepatic encephalopathy (HE) depends upon past h/o hematemesis/ melena and HE but not related to the aetiology of CLD. Rifaximin and lactulose have similar efficacy for treatment of acute HE . Purpose of this study is to compare the effectiveness of 3 modes of treatment for 7 days in terms of clinical improvement / deterioration who have or have not past h/o hematemesis/ melenaand or HE. Material and methods: After ethical clearance and consent from patient parties, 90 patients of HE of any cause and grade with or without past h/o hematemesis/melena and or HE, were categorise into different grades according to West Haven criteria and randomised to treat for 7 days with divided doses by either rifaximin 30 patients, lactulose 30 patients , rifaximin plus lactulose 30 patients. At the end, clinical improvement and deterioration were noticed. Results: Alcoholic CLD (63.33%) was the commonest. Clinical deterioration were commoner in chronic HCV (66.67%) than chronic HBV, alcoholic CLD. Patients with past h/o hematemesis /melena, clinical deterioration and improvement were 26.92% and 73.08% but without such , clinical deterioration and improvement were 2.63% and 97.37% . Patients with past h/o HE , clinical deterioration and improvement were 31.25% and 68.75% but without such past illness, clinical deteriorations and improvements were 0 and 100% . Conclusion: So clinical outcome is better in patients of HE without past h/o HE and hematemesis/melena. Keyword: Hepatic encephalopathy , chronic liver disease ,Rifaximin,Lactulose