COMPARISON OF RIFAXIMIN, LACTULOSE WITH RIFAXIMIN, LACTULOSE, BRANCHED CHAIN AMINOACIDS (BCAA) IN GRADE 1 TO GRADE 3 OF HEPATIC ENCEPHALOPATHY- NON RANDOMIZED CONTROLLED TRIAL STUDY
Journal Title: Journal of Evolution of Medical and Dental Sciences - Year 2017, Vol 6, Issue 74
Abstract
BACKGROUND Hepatic encephalopathy is presented clinically as a combination of neuropsychiatric abnormalities. It is frequently observed in those with both acute and chronic liver diseases, such as hepatic cirrhosis, alcoholic liver disease. Insufficient hepatic clearance of toxins absorbed from the intestine, can result in neurochemical abnormalities across the blood brain barrier. Presently, nonabsorbable disaccharides like Lactulose and antibiotics like Rifaximin are the mainstay of therapy. In cirrhosis of liver there is severe catabolic state, and consequent degradation of body protein is the major determinant of the characteristic amino acid imbalance with increased aromatic amino acid and decreased branched chain amino acid. So branched chain amino-acids could be effective in the treatment of hepatic encephalopathy. The aim of the study is to compare the efficacy of treatment of group who take Rifaximin, and Lactulose (group A) with the group taking Rifaximin, Lactulose and Branched Chain Amino-Acids (Group B) in Grade 1 to Grade 3 of hepatic encephalopathy. MATERIALS AND METHODS A non-randomised controlled trial study was done among 50 patients with grade 1 to grade 3 of hepatic encephalopathy. Group A (n = 25) patients received Rifaximin at 1200 mg per day in three divided doses plus Lactulose at 90 mL a day. Group B (n = 25) patients were those who receive Rifaximin plus lactulose plus Branched chain amino-acids (BCAA) at 20 g per day. The treatment duration was 14 days. Clinical parameters like grade of mental status (MS), flapping tremors (FT), number connection test (NCT), blood ammonia levels (BAL) were performed at baseline, 7th day and 14th day and estimation of Hepatic encephalopathy indexes (HEI) was done using these parameters. RESULTS Both groups showed significant improvement in HEI from baseline to 7th and 14th day. Even though the improvement was more for group B, the difference in the improvement of HEI between Group A and B was not statistically significant during the treatment period except for the severity of flapping tremor on 14th day of treatment. CONCLUSION Since the study conducted was as a non-randomised controlled trial, for better assessment of effectiveness, either a similar study with more sample size or a randomised controlled trial is desired.
Authors and Affiliations
Abhishek Basappanamalige Lokesh Reddy, Sabeena Kizhedath, Bindhu Vasudevan
Keywords
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- EP ID EP265886
- DOI 10.14260/Jemds/2017/1153
- Views 96
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