Efecto de la Lactulosa vs Rifaximina en el tratamiento de la encefalopatía hepática en adultos

Abstract

Background: Hepatic encephalopathy (HE) is a frequent and fatal complication of different liver diseases, characterized by a wide range of neuropsychiatric symptoms. Its therapeutic approach is oriented according to the type of hepatic encephalopathy; however, using disaccharides such as lactulose or antibiotics like rifaximin has often been recommended. Overall objective: To substantiate the effects of lactulose and rifaximin in adult HE patients. Methodology: Narrative literature review using the following search engines: PubMed, SciELO, and Cochrane, considering the following keywords: "liver cirrhosis," "hepatic encephalopathy," "rifaximin," "lactulose," "treatment," and Boolean connectors, for example, "AND," "OR" and "NOT," as appropriate in English and Spanish. Results: Ten observational studies, five randomized clinical trials, and four meta-analyses were included. The therapeutic approach to HD is mainly based on the indication of lactulose and rifaximin; however, the efficacy of other plasma ammonium-lowering agents, such as probiotics and L-ornithine L-aspartate, has recently been evaluated. Conclusion: Rifaximin, together with lactulose, is effective in managing HD in adult patients. The combined use of these therapeutic agents has better results than lactulose alone.