IDDF2019-ABS-0295\u2005Polyethylene glycol versus lactulose for the treatment of overt hepatic encephalopathy: a meta-analysis

Abstract

Background Hepatic encephalopathy (HE) is one of the most common causes of hospitalization in patients with cirrhosis. It poses an increasingly recognized burden on the health care system and the patient‘s quality of life. Lactulose has been the standard pharmacologic treatment for overt HE for a long time. Recently, polyethylene glycol (PEG) electrolyte solution has been studied as an alternative but only limited research has shown positive effects. Methods A comprehensive literature search from the PubMed Central, Embase, Cochrane Library, and Clinical Trials Registry was performed with the following search terms: polyethylene glycol, lactulose, and hepatic encephalopathy. Two studies were selected and validated using the Cochrane risk of bias assessment tool. Trial results were analyzed using Cochrane Review Manager Software version 5.0 with a fixed-effects model. The primary outcome of the study was improvement of HE scoring algorithm (HESA). Results Two trials comprising of 148 patients met the inclusion criteria. In the fixed-effect model (figure 1), it showed a statistically significant increase in the rates of improvement in the HESA (p<0.0001) among patients given PEG compared to those given lactulose (93.15% vs. 65.33%; RR 1.42, 95% CI: 1.19–1.69). The two trials showed moderate heterogeneity (I2= 47%). This can be due to differences in the population of the 2 studies specifically their Child-Turcotte-Pugh scores.Abstract IDDF2019-ABS-0295 Figure 1 HE resolution Conclusions PEG is an effective treatment for rapid resolution of HE. It significantly increased the rate of improvement in the HESA suggesting it may be a good alternative to the standard lactulose therapy given its rapid action.