Comparing efficacy of Rifaximin plus Lactulose vs. Lactulose alone in treating Hepatic Encephalopathy

  • Tanveer Hussain faculty member rmu
  • Misbah Sattar
  • Sara Mustafa
  • Uzma Batool
  • Shafqat Iqbal
  • Binish Hassan
Keywords: Liver Cirrhosis, Hepatic Encephalopathy, Rifaximin


Background: Hepatic Encephalopathy is a syndrome observed in patients with liver cirrhosis. Various treatment modalities are in use for treatment of Porto Systemic Encephalopathy (PSE). Our study aimed to compare the efficacy of Rifaximin plus Lactulose vs.Lactulose alone in treating Hepatic Encephalopathy in local population.

Materials & Methods: The study was conducted at a tertiary care hospital recruiting decompensated chronic liver disease(DCLD) patients with PSE. Using simple random sampling, patients were divided in two groups (A & B). Patients in group A received Lactulose plus Rifaximin while group B received Lactulose alone. Efficacy of treatment was assessed as return of the conscious level to pre-encephalopathy state as per clinical examination within 1 week after  start of the treatment.

Results: A total of 124 patients were included in the study with each group (A & B) containing 62 patients. Frequency and percentage of efficacy among group A (Rifaximin plus Lactulose) verses group B (Lactulose alone) in treating Hepatic encephalopathy was 45 (72.6%) and 32 (51.6%) respectively.

Conclusion: The study concluded that there is a significant difference in proportions of patients showing complete recovery from Hepatic encephalopathy treated with Lactulose plus Rifaximin as compared to Lactulose alone.


1. Zhou WC, Zhang QB, Qiao L. Pathogenesis of liver cirrhosis. World J Gastroenterol. 2014;20:7312–24.
2. Wiegand J, Berg T. The Etiology, Diagnosis and Prevention of Liver Cirrhosis: Part 1 of a Series on Liver Cirrhosis. DtschArzteblInt. 2013;110:85–91.
3. Romero-Gómez M, Montagnese S, Jalan R. Hepatic encephalopathy in patients with acute decompensation of cirrhosis and acute-on-chronic liver failure. Journal of Hepatology. 2015 Feb 1;62(2):437-47.
4. Shawcross DL, Sharifi Y, Canavan JB, Yeoman AD, Abeles RD, Taylor NJ, Auzinger G, Bernal W, Wendon JA. Infection and systemic inflammation, not ammonia, are associated with Grade 3/4 hepatic encephalopathy, but not mortality in cirrhosis. Journal of hepatology. 2011 Apr 1;54(4):640-9.
5. Poordad FF. Review article: the burden of hepatic encephalopathy. Aliment PharmacolTher. 2007;25Suppl 1:3-9.
6. Prasad S, Dhiman RK, Duseja A, Chawla YK, Sharma A, Agarwal R. Lactulose improves cognitive functions and health-related quality of life in patients with cirrhosis who have minimal hepatic encephalopathy. Hepatology. 2007 Mar;45(3):549-59.
7. Koo HL, DuPont HL. Rifaximin: a unique gastrointestinal-selective antibiotic for enteric diseases. Current opinion in gastroenterology. 2010 Jan;26(1):17.
8. Ong JP, Aggarwal A, Krieger D, Easley KA, Karafa MT, Van Lente F, Arroliga AC, Mullen KD. Correlation between ammonia levels and the severity of hepatic encephalopathy. The American journal of medicine. 2003 Feb 15; 114 (3):188-93.
9. Sharma BC, Sharma P, Lunia MK, Srivastava S, Goyal R, Sarin SK. A randomized, double-blind, controlled trial comparing rifaximin plus lactulose with lactulose alone in treatment of overt hepatic encephalopathy. Am J Gastroenterol. 2013;108(9):1458-63.
10. Bircher J, Benhamou JP, McIntyre N, Rizzetto M, Rodes J, editors. Oxford Textbook of Clinical Hepatology. 2nd Edition. Oxford University Press; 1999
11. Bustamante J, Rimola A, Ventura PJ, Navasa M, Cirera I, Reggiardo V, Rodés J. Prognostic significance of hepatic encephalopathy in patients with cirrhosis. Journal of hepatology. 1999 May 1;30(5):890-5.
12. Perri, GA, Khosravani H. Complications of end-stage liver disease. Can Fam Physician 2016;62(1):44–50.
13. Poordad FF. Presentation and complications associated with cirrhosis of the liver. Curr Med Res Opin 2015;31:925-37.
How to Cite
Hussain T, Sattar M, Mustafa S, Batool U, Iqbal S, Hassan B. Comparing efficacy of Rifaximin plus Lactulose vs. Lactulose alone in treating Hepatic Encephalopathy. JRMC [Internet]. 30Dec.2020 [cited 24Sep.2022];24(4):339-43. Available from: