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Rifaximin, probiotics, LOLA improved scores for minimal HE in liver cirrhosis
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Patients with cirrhosis and minimal hepatic encephalopathy showed improvements in critical flicker frequency and neuropsychometric tests after treatment with rifaximin, probiotics or l-ornithine l-aspartate, according to new study data.
Researchers, including Kapil Sharma, MD, DM, of the department of hepatology at the Institute of Liver and Biliary Sciences, India, studied 206 patients with cirrhosis and determined that 60.19% also had minimal hepatic encephalopathy (MHE). They randomly assigned these patients to l-ornithine l-aspartate (LOLA; n=31), rifaximin (n=31), probiotics (n=32) or placebo (n=30) for 2 months. Patients in the LOLA group were assigned 18 g daily in three doses; the rifaximin group was given 400 mg three times daily; and the probiotics group received two capsules daily.
Kapil Sharma
“MHE is a subclinical form of HE with no recognizable clinical symptoms of HE, but with mild cognitive and psychomotor deficits,” Sharma told Healio.com/Hepatology. “Its diagnosis rests on careful patient history and physical examination, normal mental status examination, demonstration of abnormalities in cognition and/or neurophysiological function and exclusion of concomitant neurological disorders.”
Before treatment, researchers said 70.16% of the cohort displayed an abnormal critical flicker frequency (CFF) test, 90.32% had two or more abnormal neuropsychometric tests (NPT) and 60.48% had both. Analysis showed that 67.7% of LOLA patients, 70.9% from the rifaximin group, 50% in the probiotics group and 30% of placebo patients improved after therapy. CFF scores were higher and NPT showed improvement among all drug groups vs. placebo patients (P<.05). There were no significant differences in effect between groups using ANOVA; however, post hoc testing indicated LOLA to have the best mean effect.
“Prevalence of MHE is high in patients with cirrhosis of the liver; it was 60.19% in our study,” Sharma told Healio.com/Hepatology. “Rifaximin, LOLA and probiotics are better than giving none of these in patients with MHE.”
Disclosure: The researchers report no relevant financial disclosures.