Cyclic treatment of chronic hepatic encephalopathy with rifaximin. Results of a double-blind clinical study.
BACKGROUND
Chronic hepatic encephalopathy (HE) represents a frequent and serious complication of chronic liver disease. Aim of the study is to comparatively evaluate the effect of rifaximin, lactitol and their combination in treating chronic HE.


METHODS
Forty out-patients (29 males, 11 females, mean age: 59 years, range 40-70), with viral liver cirrhosis and chronic HE (1st-2nd degree) were studied. HE was assessed by considering: mental state, asterixis, number connection test (NCT), arterial blood ammonia levels. Patients were randomly assigned to the following treatments: rifaximin (plus sorbitol as placebo) (group R); lactitol (group L); rifaximin plus lactitol (group RL). All treatments were continued for 15 days for 3 cycles, intervalled by 15 days of washout.


RESULTS
The 3 treatments reduced HE, but with different efficacy: patients of group R and RL significantly (p<0.05) documented a faster improvement in HE degree, a higher percentage of patients which normalized mental state and NCT, a faster improvement of asterixis and a longer persistence of normal ammonia levels than patients of group L.


CONCLUSIONS
Rifaximin in combination with lactitol or sorbitol represents an effective and safe treatment of chronic HE.
Gastroenterology School, Second University of Naples, Naples. carmelina.loguercio@unina2.it
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Loguercio
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Federico
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De Girolamo
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Ferrieri
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Del Vecchio Blanco