Saturday, April 18, 2015

Colon cleanse for hepatic encephalopathy?

From JAMA Internal Medicine:

We hypothesized that rapid catharsis of the gut using PEG may resolve HE more effectively than lactulose...

Design, Setting, and Participants The HELP (Hepatic Encephalopathy: Lactulose vs Polyethylene Glycol 3350-Electrolyte Solution) study is a randomized clinical trial in an academic tertiary hospital of 50 patients with cirrhosis (of 186 screened) admitted for HE.

Interventions Participants were block randomized to receive treatment with PEG, 4-L dose (n = 25), or standard-of-care lactulose (n = 25) during hospitalization.

Main Outcomes and Measures The primary end point was an improvement of 1 or more in HE grade at 24 hours, determined using the hepatic encephalopathy scoring algorithm (HESA), ranging from 0 (normal clinical and neuropsychological assessments) to 4 (coma). Secondary outcomes included time to HE resolution and overall length of stay.

Results A total of 25 patients were randomized to each treatment arm. Baseline clinical features at admission were similar in the groups. Thirteen of 25 patients in the standard therapy arm (52%) had an improvement of 1 or more in HESA score, thus meeting the primary outcome measure, compared with 21 of 23 evaluated patients receiving PEG (91%) (P less than .01); 1 patient was discharged before final analysis and 1 refused participation. The mean (SD) HESA score at 24 hours for patients receiving standard therapy changed from 2.3 (0.9) to 1.6 (0.9) compared with a change from 2.3 (0.9) to 0.9 (1.0) for the PEG-treated groups (P = .002). The median time for HE resolution was 2 days for standard therapy and 1 day for PEG (P = .01). Adverse events were uncommon, and none was definitely study related.

Conclusions and Relevance PEG led to more rapid HE resolution than standard therapy, suggesting that PEG may be superior to standard lactulose therapy in patients with cirrhosis hospitalized for acute HE.

1 comment:

Jorge Gonzalez said...

Hello. My Father has HE. How would we go about asking for this treatment (PEG-3350 Electrolyte solution) from his primary care physicians? He had not had an HE episode for more than a year using Lactulose treatments (30-45 mg per dose) producing 2-3 bowel movements per day. However, this past week he has had two acute episodes as well as a mild episode (confused but functional). He has not had as many bowel movements this past week -- only 1-2 per day -- and I believe it is compounding the problem.