Polyethylene glycol versus lactulose in the treatment of hepatic encephalopathy: a systematic review and meta-analysis
Background Hepatic encephalopathy (HE) is defined as brain dysfunction that occurs because of acute liver failure or liver cirrhosis and is associated with significant morbidity and mortality. Lactulose is the standard of care till this date; however, polyethylene glycol (PEG) has gained the attenti...
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BMJ Publishing Group
2021-10-01
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| Series: | BMJ Open Gastroenterology |
| Online Access: | https://bmjopengastro.bmj.com/content/8/1/e000648.full |
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| author | Gilles Jadd Hoilat Mohamad Fekredeen Ayas Judie Noemie Hoilat Ahmed Abu-Zaid Ceren Durer Seren Durer Talal Adhami Savio John |
| author_facet | Gilles Jadd Hoilat Mohamad Fekredeen Ayas Judie Noemie Hoilat Ahmed Abu-Zaid Ceren Durer Seren Durer Talal Adhami Savio John |
| author_sort | Gilles Jadd Hoilat |
| collection | DOAJ |
| description | Background Hepatic encephalopathy (HE) is defined as brain dysfunction that occurs because of acute liver failure or liver cirrhosis and is associated with significant morbidity and mortality. Lactulose is the standard of care till this date; however, polyethylene glycol (PEG) has gained the attention of multiple investigators.Methods We screened five databases namely PubMed, Scopus, Web of Science, Cochrane Library and Embase from inception to 10 February 2021. Dichotomous and continuous data were analysed using the Mantel-Haenszel and inverse variance methods, respectively, which yielded a meta-analysis comparing PEG versus lactulose in the treatment of HE.Results Four trials with 229 patients were included. Compared with lactulose, the pooled effect size demonstrated a significantly lower average HE Scoring Algorithm (HESA) Score at 24 hours (Mean difference (MD)=−0.68, 95% CI (−1.05 to –0.31), p<0.001), a higher proportion of patients with reduction of HESA Score by ≥1 grade at 24 hours (risk ratio (RR)=1.40, 95% CI (1.17 to 1.67), p<0.001), a higher proportion of patients with a HESA Score of grade 0 at 24 hours (RR=4.33, 95% CI (2.27 to 8.28), p<0.0010) and a shorter time to resolution of HE group (MD=−1.45, 95% CI (−1.72 to –1.18), p<0.001) in favour of patients treated with PEG.Conclusion PEG leads to a higher drop in the HESA Score and thus leads to a faster resolution of HE compared with lactulose. |
| format | Article |
| id | doaj-art-e287e68ec6964a579c7314f8a00c88aa |
| institution | Kabale University |
| issn | 2054-4774 |
| language | English |
| publishDate | 2021-10-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open Gastroenterology |
| spelling | doaj-art-e287e68ec6964a579c7314f8a00c88aa2024-12-07T15:25:09ZengBMJ Publishing GroupBMJ Open Gastroenterology2054-47742021-10-018110.1136/bmjgast-2021-000648Polyethylene glycol versus lactulose in the treatment of hepatic encephalopathy: a systematic review and meta-analysisGilles Jadd Hoilat0Mohamad Fekredeen Ayas1Judie Noemie Hoilat2Ahmed Abu-Zaid3Ceren Durer4Seren Durer5Talal Adhami6Savio John7Internal Medicine, SUNY Upstate Medical University, Syracuse, New York, USAInternal Medicine, Ascension St John Hospital, Detroit, Michigan, USAInternal Medicine, Loyola University Medical Center, Maywood, Illinois, USADepartment of Pharmacology, The University of Tennessee Health Science Center, Memphis, Tennessee, USAInternal Medicine, SUNY Upstate Medical University, Syracuse, New York, USAInternal Medicine, SUNY Upstate Medical University, Syracuse, New York, USAGastroenterology, Cleveland Clinic Foundation, Cleveland, Ohio, USAGastroenterology, SUNY Upstate Medical University, Syracuse, New York, USABackground Hepatic encephalopathy (HE) is defined as brain dysfunction that occurs because of acute liver failure or liver cirrhosis and is associated with significant morbidity and mortality. Lactulose is the standard of care till this date; however, polyethylene glycol (PEG) has gained the attention of multiple investigators.Methods We screened five databases namely PubMed, Scopus, Web of Science, Cochrane Library and Embase from inception to 10 February 2021. Dichotomous and continuous data were analysed using the Mantel-Haenszel and inverse variance methods, respectively, which yielded a meta-analysis comparing PEG versus lactulose in the treatment of HE.Results Four trials with 229 patients were included. Compared with lactulose, the pooled effect size demonstrated a significantly lower average HE Scoring Algorithm (HESA) Score at 24 hours (Mean difference (MD)=−0.68, 95% CI (−1.05 to –0.31), p<0.001), a higher proportion of patients with reduction of HESA Score by ≥1 grade at 24 hours (risk ratio (RR)=1.40, 95% CI (1.17 to 1.67), p<0.001), a higher proportion of patients with a HESA Score of grade 0 at 24 hours (RR=4.33, 95% CI (2.27 to 8.28), p<0.0010) and a shorter time to resolution of HE group (MD=−1.45, 95% CI (−1.72 to –1.18), p<0.001) in favour of patients treated with PEG.Conclusion PEG leads to a higher drop in the HESA Score and thus leads to a faster resolution of HE compared with lactulose.https://bmjopengastro.bmj.com/content/8/1/e000648.full |
| spellingShingle | Gilles Jadd Hoilat Mohamad Fekredeen Ayas Judie Noemie Hoilat Ahmed Abu-Zaid Ceren Durer Seren Durer Talal Adhami Savio John Polyethylene glycol versus lactulose in the treatment of hepatic encephalopathy: a systematic review and meta-analysis BMJ Open Gastroenterology |
| title | Polyethylene glycol versus lactulose in the treatment of hepatic encephalopathy: a systematic review and meta-analysis |
| title_full | Polyethylene glycol versus lactulose in the treatment of hepatic encephalopathy: a systematic review and meta-analysis |
| title_fullStr | Polyethylene glycol versus lactulose in the treatment of hepatic encephalopathy: a systematic review and meta-analysis |
| title_full_unstemmed | Polyethylene glycol versus lactulose in the treatment of hepatic encephalopathy: a systematic review and meta-analysis |
| title_short | Polyethylene glycol versus lactulose in the treatment of hepatic encephalopathy: a systematic review and meta-analysis |
| title_sort | polyethylene glycol versus lactulose in the treatment of hepatic encephalopathy a systematic review and meta analysis |
| url | https://bmjopengastro.bmj.com/content/8/1/e000648.full |
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