Non-Absorbable Disaccharides for Hepatic Encephalopathy: A Systematic Review and Meta-Analysis.
Hepatology. 2016 Apr 15;
Authors: Gluud LL, Vilstrup H, Morgan MY
Non-absorbable disaccharides (NADs) have been used to treat hepatic encephalopathy (HE) since 1966. However, a Cochrane review, published in 2004, found insufficient evidence to recommend their use in this context. This updated systematic review evaluates the effects of the NADs, lactulose and lactitol, for the treatment and prevention of HE in patients with cirrhosis. Thirty-eight randomized controlled trials (RCTs), involving 1828 patients, were identified via electronic and manual searches; 31 RCTs looked at the treatment of HE while seven looked at its primary/secondary prevention. Random-effects meta-analyses showed that, compared to placebo/no intervention, NADs had a beneficial effect on HE (relative risk [RR], 0.63; 95% confidence interval [CI], 0.53-0.74; Number Needed to Treat [NNT] = 4) and serious liver-related adverse events such as: liver failure, variceal bleeding, serious infections, spontaneous bacterial peritonitis and hepatorenal syndrome (RR, 0.42; 95% CI, 0.26-0.69; NNT = 50). Treatment was also associated with a reduction in mortality in patients with overt HE (RR, 0.36; 95% CI, 0.14-0.94; NNT = 20), although not in patients with minimal HE. Meta-analyses of the prevention RCTs showed that NADs prevented the development of HE (RR, 0.47; 95% CI, 0.33-0.68; NNT = 6), the risk of developing serious liver-related adverse events (RR, 0.48; 95% CI, 0.33-0.70; NNT = 6), and reduced mortality (RR, 0.63; 95% CI, 0.40-0.98; NNT = 20). Use of NADs was associated with non-serious gastrointestinal adverse events. There were no differences in the efficacy or safety of lactulose and lactitol.
CONCLUSIONS: NADs have beneficial effects in the treatment and prevention of HE; their use, in this context, confers additional benefits including a reduction in serious liver-related morbidities and all-cause mortality. This article is protected by copyright. All rights reserved.
PMID: 27081787 [PubMed - as supplied by publisher]