title: Minimal hepatic encephalopathy in cirrhosis- how long to treat?
abstract: BACKGROUND
  Minimal hepatic encephalopathy (MHE) can reverse after short-term treatment. However, relapse rate of MHE after stopping treatment has not been studied so far. We aimed to evaluate long-term (9 months) efficacy of a short-term (3 months) treatment of MHE with lactulose/rifaximin, for maintenance of remission from MHE.
  
  
  METHODS
  In this prospective study, consecutive patients with cirrhosis and MHE were treated with lactulose/rifaximin for 3 months. After treatment, they were followed up for 6 months. Psychometric testing for diagnosis of MHE was performed at baseline, 3 months and 9 months.
  
  
  RESULTS
  Of the 527 patients screened, 351 were found eligible and tested for MHE. Out of these, 112 (31.9%) patients had MHE (mean age 55.3 years; 75% males). They were randomized to receive Rifaximin (n = 57; 1,200 mg/day) or Lactulose (n = 55; 30-120 mL/day) for three months. At 3 months, 73.7% (42/57) patients in Rifaximin group experienced MHE reversal compared to 69.1% (38/55) in Lactulose group (p = 0.677). Six months after stopping treatment, 47.6% (20/42) in rifaximin group and 42.1% (16/38) patients in lactulose group experienced MHE relapse (p = 0.274). The overt hepatic encephalopathy development rate (7.1% vs. 7.9%) and mortality rate (0.23% vs. 0%) were similar in both groups. The Child-Turcotte-Pugh score and model for end stage liver disease (MELD) scores of patients who had MHE relapse were higher compared to those who didn't. On multivariate regression analysis, MELD score was an independent predictor of MHE relapse.
  
  
  CONCLUSIONS
  Of the patients who became MHE negative after short-term (3 months) treatment with rifaximin/lactulose, almost 50% had a relapse of MHE at 6 months follow-up.
authors.affiliation: Dayanand Medical College and Hospital, Ludhiana, Punjab, India.
authors.forename: Omesh
authors.initials: O
authors.lastname: Goyal
authors.affiliation: Dayanand Medical College and Hospital, Ludhiana, Punjab, India.
authors.forename: Sandeep S
authors.initials: SS
authors.lastname: Sidhu
authors.affiliation: Dayanand Medical College and Hospital, Ludhiana, Punjab, India.
authors.forename: Harsh
authors.initials: H
authors.lastname: Kishore
mesh_terms: D004334:Drug Administration Schedule; D005260:Female; D006501:Hepatic Encephalopathy / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D007194:India; D007792:Lactulose / Q000008:administration & dosage* / Q000009:adverse effects; D008103:Liver Cirrhosis / Q000150:complications* / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009483:Neuropsychological Tests; D011446:Prospective Studies; D011594:Psychometrics; D012008:Recurrence; D012074:Remission Induction; D012294:Rifamycins / Q000008:administration & dosage* / Q000009:adverse effects; D000078262:Rifaximin; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D012294:Rifamycins; D007792:Lactulose; D000078262:Rifaximin