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PEG solution improved hepatic encephalopathy in cirrhotic patients

Treatment with polyethylene glycol 3350-electrolyte solution, or PEG, improved overt hepatic encephalopathy among patients with cirrhosis faster vs. standard of care treatment with lactulose, according to recent study data.    

“Lactulose has been the standard of care for many years, dating back to the 1960s. However, the efficacy hasn’t really been looked at in greater detail, but rather adopted,” researcher Robert Rahimi, MD, a transplant hepatologist at Baylor University Medical Center, said in a press release. “If you look at the high-quality studies from a Cochrane meta-analysis, lactulose is actually no better than placebo, so we hypothesized that by purging the gastrointestinal tract with PEG, we could potentially improve outcomes in patients hospitalized for [hepatic encephalopathy].”

Robert Rahimi

Fifty patients (mean age, 56 years) were randomly assigned to three or more doses of lactulose (n=25) or a single dose of 4 L of PEG (n=25) in a 24-hour period while hospitalized at Parkland Memorial Hospital in Dallas. Researchers measured hepatic encephalopathy scoring algorithm (HESA) scores at baseline and after treatment to determine any differences between the patient groups. Twenty-five patients in the lactulose group and 23 in the PEG group were included in final analyses.

After comparing 24-hour HESA scores, researchers found that 52% of patients in the lactulose group had improved by one or more HESA score compared with 91% of patients in the PEG group (P<.01). The patients in the PEG group had a lower mean HESA score at 24 hours compared with patients in the lactulose group (0.9 vs. 1.6; P=.002).

Patients in the PEG group had a shorter median time of hospital day of 1 day compared with 2 days for patients in the lactulose group (P=.01).  

“On average, [the hospital stay for acute HE] can be about 5 days overall, depending on the underlying precipitant,” Rahimi said. “In patients who took the PEG solution, [hepatic encephalopathy] resolved 1 day quicker. There’s an overall potential for decreased length of stay, which could result in cost savings.

“Because lactulose is the standard of care for outpatients as well, this new research might lead to different medicines that can be used from an outpatient standpoint, which could help prevent patients from even getting hospitalized in the first place,” Rahimi said.