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BACKGROUND: Hepatic encephalopathy is a serious manifestation of hepatic disease which can lead to death. Several drugs are prescribed in its treatment. Rifaximin-a (RFX) has been used successfully in the treatment of open hepatic encephalopathy, in the prevention of recurrent hepatic encephalopathy and in minimal hepatic encephalopathy. OBJECTIVE: To perform a shallow analysis of the costs of the treatment of hepatic encephalopathy with Mexican prices. MATERIAL AND METHOD: A retrospective study was done with the published data on efficacy, maximal public price of rifaximin-a, neomycin, lactulose, L-ornithine L-aspartate, and the hospital costs of Mexican Institute of Social Security published for the year 2018, a cost minimization analysis, the cost for an episode of open hepatic encephalopathy and for prevention of recurrence of hepatic encephalopathy were calculated. RESULTS: Considering similar therapeutic efficacy, the cost minimization analysis showed that the treatment with rifaximin was cost saving compared with therapeutic alternatives. In overt hepatic encephalopathy the combination of rifaximin with lactulose, that has been considered the most effective approach, resulted cost-effective due to shorter hospitalization. The cost of one-year continuous treatment to prevent recurrence of hepatic encephalopathy was 64,330 Mexican pesos per patient with rifaximin and 172,012 Mexican pesos with lactulose. CONCLUSIONS: Rifaximin-a is a dominant alternative of treatment of open hepatic encephalopathy and for the prevention of hepatic encephalopathy recurrence. [ABSTRACT FROM AUTHOR]

BACKGROUND: Hepatic encephalopathy (HE) is a neuropsychiatric syndrome. HE is characterized for a cognitive and motor deficiency with different severity states. Despite HE has been treated for many years, there is not definitive evidence about the therapeutic effects. OBJECTIVE: To analyze if a combined therapy of oral (OV) lactulose and intravenous (IV) metronidazole decrease the hospital stay compared with oral lactulose or IV or OV metronidazole monotherapy. MATERIAL AND METHOD: A retrospective study was made. We analyzed 60 medical records from patients with HE diagnosis (West Haven grade II-IV) from Xoco General Hospital, Mexico City. Patients were divided into three groups according with therapy: metronidazole + lactulose (n=23), metronidazole (n=24) and lactulose (n=13). Statistical analysis was made in VassarStats. ANOVA was used to compare differences between groups. RESULTS: When correlating the hospital stay with type of therapy administered for the three groups there was a value p=0.15. Variables as HE grade, type of therapy and hospital stay time correlated p=0.12 in patients with HE grade II and p=0.03 for HE grade III patients. CONCLUSION: Monotherapy or combination of metronidazole and lactulose did not decrease the hospital stay of HE grade II patients. HE grade IV patients with metronidazole + lactulose therapy, however, had decreased hospital stay. [ABSTRACT FROM AUTHOR]

BACKGROUND : Hepatic encephalopathy is a clinical picture comprising a variety of neuropsychological disorders in cognitive and emotional areas, personality, motor activity, memory and consciousness, being able to progress to coma. Treatment with lactulose and metronidazole has improved the prognosis; however, there are patients with poor response to this therapy. OBJECTIVE: To compare the effectiveness of different antiamonio therapies coupled to the therapeutic measures of the precipitating cause, such as treatment of hepatic encephalopathy. MATERIAL AND METHOD: An experimental, comparative, longitudinal, prospective, controlled and blinded clinical trial. A total of 88 patients were randomized into three groups: group A lactulose (n=30) group B metronidazole (n=29) and group C LOLA (n=29); degree of hepatic encephalopathy was determined and venous blood simple was taken to measure ammonia levels, treatment was initiated based on lactulose or metronidazole or Hepa-Merz®. Ammonium was determined again and degree of encephalopathy was determined at hospital discharge. RESULTS: The average age of the patients was 51.3±10.3, 51.8±15.2 and 48.3±13.4 years, respectively; p=0.264 when comparing the groups according to the degree of hepatic encephalopathy at admission and discharge was obtained. In addition, p=0.207 when comparing the length of hospital stay was obtained. Finally quantity ammonium was compared before and after treatment obtaining a p=0.028 in the lactulose group and p=0.009 in the Hepa-Merz® group, without finding significance for the metronidazole group (p=0.294). CONCLUSIONS: Treatment with lactulose and Hepa-Merz® significantly reduces ammonia concentration in patients with hepatic encephalopathy, with no differences in terms of relief of hepatic encephalopathy or days of hospital stay. [ABSTRACT FROM AUTHOR]

Background: Overt hepatic encephalopathy (HE) is associated with poor prognosis in patients with cirrhosis. Since neurocognitive deficits following an episode of HE may not be fully reversible, prophylactic therapy of overt HE is warranted. Objective: To evaluate whether the use of lactulose reduce the incidence of clinically overt hepatic encephalopathy in bleeding cirrhotic patients. Material and method: We searched MEDLINE, EMBASE, and CENTRAL for randomized controlled trials comparing lactulose with placebo or no intervention in adult patients with liver cirrhosis and acute GI bleeding. To be eligible, studies must assess the efficacy of lactulose in preventing an episode of overt hepatic encephalopathy as primary prophylaxis. Two reviewers extracted data, assessed risk of bias and summarized strength of evidence using the GRADE approach. Results: Low quality evidence from two trials suggested that lactulose significantly reduce the incidence of overt HE in bleeding cirrhotic patients (relative risk, 0.30 [95% CI, 0.14 to 0.64, p=0.002] I2=0%). Compared with no intervention, lactulose significantly increased the incidence of diarrhea (relative risk, 10.23 [95% CI, 1.31 to 79.84, p=0.03]; I2=0%). Conclusions: The available evidence suggests a potential effect of lactulose in the prevention of overt hepatic encephalopathy in bleeding cirrhotic patients. Further research is necessary to clarify effects on long-term clinical outcomes and safety. [ABSTRACT FROM AUTHOR]