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Polyethylene Glycol Versus Lactulose for Hepatic Encephalopathy

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Overt hepatic encephalopathy (HE) is a serious complication of cirrhosis that has few treatment options and often necessitates hospitalization. A randomized controlled trial compared polyethylene glycol (PEG) with lactulose, the latter of which is considered the standard of care for overt HE but has several drawbacks, including the risk of significant adverse effects (AEs), particularly in the setting of overtreatment.

The trial included 100 patients with post-hepatitis C cirrhosis who were admitted to the hospital with HE. Patients were randomized to lactulose or PEG. Three patients died within 24 hours of admission and did not complete follow-up, but were considered as treatment failure in the intention-to-treat analysis.  After 24 hours of treatment, 94% of patients in the PEG group (n = 47) and 72% of patients in the lactulose group (n= 36) improved one grade or more in the hepatic encephalopathy scoring algorithm (P<.05). The PEG group also required less time for HE resolution and had shorter hospital lengths of hospital (P<.001). Both therapies were tolerated, with no significant AEs reported.

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Shehata HH, Elfert AA, Abdin AA, et al. Randomized controlled trial of polyethylene glycol versus lactulose for the treatment of overt hepatic encephalopathy. Eur J Gastroenterol Hepatol. 2018 Sep 18. doi: 10.1097/MEG.0000000000001267.