Polyethylene glycol versus lactulose in the treatment of hepatic encephalopathy: a systematic review and meta-analysis

BackgroundHepatic 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 attentio...

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Bibliographic Details
Published in:BMJ open gastroenterology 2021-05, Vol.8 (1), p.e000648
Main Authors: Hoilat, Gilles Jadd, Ayas, Mohamad Fekredeen, Hoilat, Judie Noemie, Abu-Zaid, Ahmed, Durer, Ceren, Durer, Seren, Adhami, Talal, John, Savio
Format: Article
Language:English
Subjects:
Bias
Brain research
Hepatology
Intervention
Liver cirrhosis
Meta-analysis
Pathogenesis
Polyethylene glycol
Sensitivity analysis
Software
Systematic review
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Summary:BackgroundHepatic 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.MethodsWe 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.ResultsFour 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
ISSN:2054-4774
2054-4774
DOI:10.1136/bmjgast-2021-000648