Hepatic Encephalopathy; to Compare the Efficacy of Lactulose Alone and Lactulose with Rifaxamin in Patients of Hepatic Encephalopathy

.. Background: Hepatic encephalopathy is one of the fatal complications of liver cirrhosis in clinical setting. A number of drugs with varied response have been tried up till now. Objectives: To compare the efficacy of lactulsoe alone and in combination with rifaxamin in cases with hepatic encephalopathy. Study Design: Randomized control trail. Setting: Sheikh Zayed Hospital (SZH) Rahim Yar Khan (RYK). Period: January 2015 to October 2015. Patients and Methods: 120 cases of liver cirrhosis with encephalopathy were randomized into different grades according to West Haven’s criteria. These cases were then equally divided into group A and B. Group A was treated with lactulose alone while group B was treated with lactulose plus rifaxamin with their standard doses. The cases were assessed for their improvement in symptoms on West Haven’s scale and the cases with complete resolution of symptoms were labeled as cured. The mortality benefit was also noted. Results: The mean age was 43.24± 8.34 years and mean duration of symptoms was 3.45± 0.8 days. There was no significant difference in terms of child pugh score in both groups with p= 0.69. There was also no significant difference in both groups in terms of grades of encephalopathy (p= 0.21). However there was significant better efficacy and decreased mortality in group B as compared to A with p values of 0.02 and 0.03 respectively. Conclusion: Lactulose combined with rifaxamin has significant improvement in encephalopathy as well as in reducing mortality in comparison with lactulsoe alone