Lactulose 3.1-3.7g/5ml oral solution

This systematic review aimed to compare the clinical efficacy of rifaximin versus lactulose in the management of hepatic encephalopathy (HE) by analyzing evidence from randomized controlled trials (RCTs). A comprehensive search across major databases identified seven eligible RCTs encompassing 693 adult patients diagnosed with overt or minimal HE. Findings demonstrated that rifaximin is at least as effective as lactulose in reversing HE symptoms, with some studies reporting significantly higher HE reversal rates when rifaximin was used in combination with lactulose (e.g., 76% vs. 50.8%, ppp=0.001). While other trials reported similar efficacy between the two agents (e.g., HE improvement: 84.4% vs. 95.4%, p=0.315), rifaximin was generally associated with better tolerability and fewer gastrointestinal side effects. These results support rifaximin as an effective and well-tolerated therapeutic option, either as monotherapy or in combination with lactulose. Further large-scale, multicenter trials are warranted to assess long-term outcomes, recurrence rates, and cost-effectiveness.

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Background: Hepatic Encephalopathy (HE), a neuropsychiatric complication of hepatic failure, is currently managed with lactulose as a first-line treatment followed by other adjuncts if needed. In this meta-analysis, we determined the effect of lactulose and rifaximin combination in terms of efficacy and mortality reduction compared to lactulose alone. Materials and Methods: We searched databases (PubMed, BioMed Central, and Cochrane-Central) until July 2022 for original studies inspecting the effects of Rifaximin and Lactulose (combination therapy) vs. lactulose as a monotherapy in the treatment of HE on outcomes of clinical efficacy, hospital stay length, HE recurrence, drugs’ side effects and mortality. Data was analyzed via Review Manager (version 5.4.1) and OpenMetaAnalyst. Relative risks (RR) and weighted mean differences (WMD) with 95% confidence intervals were calculated. Results: Fifteen studies with 4327 patients were included. Pooled analysis showed combination therapy to be associated with a significantly lower mortality rate in patients having HE when compared to lactulose alone (RR 0.71 95% CI 0.58-0.88, P=0.002, I2= 68%), and clinical efficacy was also improved in the combination group (RR 1.33, 95%CI 1.19-1.48, P <0.00001, I2= 52%). HE recurrence rate, adverse events, and length of hospital stay did not significantly differ among the two groups (RR= 0.61, 95 % CI= 0.35 to 1.05, P= 0.08, I2= 84%), (RR= 0.92, 95% CI= 0.51 to 1.69, P= 0.80, I2 = 0) and (WMD −1.52, 95% CI −3.22 to 0.18, P=0.08, I2 = 83%) respectively. Conclusions: Combination therapy shows survival benefits and superior clinical efficacy over lactulose monotherapy in managing hepatic encephalopathy.

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BackgroundMinimal hepatic encephalopathy (MHE) represents a reversible, early-stage form of hepatic encephalopathy (HE). Although probiotics have been extensively studied for MHE management, direct comparative evidence against standard lactulose therapy remains limited. This meta-analysis aimed to quantitatively evaluate the relative efficacy and safety of probiotics versus lactulose in cirrhotic patients with MHE.MethodsPubMed, the Cochrane Library, Embase, Web of Science, and the Chinese Biomedical Literature Database (CBM) were systematically searched from inception to August 2025 to identify randomized controlled trials (RCTs) comparing probiotics with lactulose for the treatment of MHE in patients with cirrhosis. Extracted outcomes included MHE reversal, overt hepatic encephalopathy (OHE) development, serum ammonia reduction, and adverse events (AEs).ResultsFive studies involving 345 cirrhotic patients were included. Pooled analyses showed no statistically significant differences between probiotics and lactulose in reversing MHE (RR: 0.98, 95% CI: 0.79-1.20; p = 0.822), preventing OHE development (RR: 1.40, 95% CI: 0.75-2.61; p = 0.289), and reducing serum ammonia levels (SMD: -0.05, 95% CI: -0.29 to 0.19; p = 0.678). In contrast, probiotics were associated with a significantly lower incidence of AEs compared with lactulose (RR: 0.17, 95% CI: 0.05-0.60; p = 0.005).ConclusionThis meta-analysis found no evidence that probiotics are superior or inferior to lactulose in terms of MHE reversal, prevention of OHE, and reduction of serum ammonia levels. Probiotics were associated with fewer AEs, suggesting a potential safety advantage. Further large-scale, high-quality RCTs are warranted to confirm these findings.

Abstract licence: CC BY