An Overview of Polyethylene Glycol with Lactulose as Additional Therapy in the Treatment of Hepatic Encephalopathy

Authors

  • Vishnu Bagavath Gnanasekar Department of Pharmacy Practice, PSG College of Pharmacy, Coimbatore-641004, Tamil Nadu, India.
  • Sivakumar Veluswamy Department of Pharmacy Practice, PSG College of Pharmacy, Coimbatore-641004, Tamil Nadu, India

DOI:

https://doi.org/10.55940/medphar202469

Keywords:

Covert and Overt Hepatic Encephalopathy, Hepatic Encephalopathy, Lactulose, Polyethylene Glycol

Abstract

 Background: Hepatic encephalopathy (HE) is a condition marked by compromised brain function resulting from liver dysfunction, often linked to acute liver failure or cirrhosis, with notable morbidity and mortality. Lactulose has been the conventional treatment, but polyethylene glycol (PEG) has garnered interest from several investigators Aim: To provide an overview of PEG as add on therapy in the Management of HE. This review aims to function as a resource for clinicians, providing evidence on therapeutic decisions of Polyethylene glycol in hepatic encephalopathy. Method: We conducted a comphrensive search across five prominent databases, specifically Scopus, Web of Science, PubMed, Embase, and Cochrane Library.. Moreover, additional records were identified through alternative channels, such as Google Scholar Results: According to the findings, polyethylene glycol (PEG) has a beneficial effect on the management of hepatic encephalopathy (HE). Five randomized studies involving a total of 300 patients were conducted. PEG therapy was found to have a substantial benefit in terms of improving clinical efficacy and reducing hospital stays. Conclusion: From the results show that PEG is a successful treatment for HE. When PEG is used in place of lactulose, shorter stays are possible without raising the frequency of unfavourable events, and HE resolution can occur more quickly during the first twenty-four hours.

Author Biographies

Vishnu Bagavath Gnanasekar , Department of Pharmacy Practice, PSG College of Pharmacy, Coimbatore-641004, Tamil Nadu, India.

 

 

Sivakumar Veluswamy , Department of Pharmacy Practice, PSG College of Pharmacy, Coimbatore-641004, Tamil Nadu, India

 

 

References

Rose CF, Amodio P, Bajaj JS, Dhiman RK, Montagnese S, Taylor-Robinson SD, Vilstrup H, Jalan R. Hepatic encephalopathy: Novel insights into classification, pathophysiology and therapy. Journal of hepatology. 2020;73(6):1526-47. DOI: 10.1016/j.jhep.2020.07.013

Ferenci P. Hepatic encephalopathy. Gastroenterology report. 2017 May 1;5(2):138-47. DOI 10.1093/gastro/gox013

Ferenci P, Lockwood A, Mullen K, Tarter R, Weissenborn K, Blei AT. Hepatic encephalopathy - Definition, nomenclature, diagnosis, and quantification: Final report of the Working Party at the 11th World Congresses of Gastroenterology, Vienna, 1998. Hepatology. 2002;35(3):716–21. DOI: 10.1053/jhep.2002.31250

Mubashir W, Sharik M, Ahad W, Aamir S, Riaz I. Hepatic Encephalopathy: A Comprehensive Review. Acta Scientific Gastrointestinal Disorders. 2022;5(7):67-71

Ortiz M, Córdoba J, Doval E, Jacas C, Pujadas F, Esteban R, et al. Development of a clinical hepatic encephalopathy staging scale. Aliment Pharmacol Ther. 2007;26(6):859–67. DOI: 10.1111/j.1365-2036.2007.03394.x

Hassanein TI, Hilsabeck RC, Perry W. Introduction to the hepatic encephalopathy scoring algorithm (HESA). Dig Dis Sci. 2008;53(2):529–38. DOI: 10.1007/s10620-007-9895-0

Elsaid MI, Rustgi VK. Epidemiology of Hepatic Encephalopathy. Clin Liver Dis. 2020;24(2):157-174. DOI: 10.1016/j.cld.2020.01.001

Wong RJ, Gish RG, Ahmed A. Hepatic encephalopathy is associated with significantly increased mortality among patients awaiting liver transplantation. Liver Transplant. 2014;20(12):1454–61. DOI: 10.1002/lt.23981

Poordad FF. The burden of hepatic encephalopathy. Alimentary pharmacology & therapeutics. 2007 Feb;25:3-9. DOI: 10.1111/j.1746-6342.2006.03215.x

Stepanova M, Mishra A, Venkatesan C, Younossi ZM. In-hospital mortality and economic burden associated with hepatic encephalopathy in the United States from 2005 to 2009. Clinical gastroenterology and hepatology. 2012 ;10(9):1034-41. DOI: 10.1016/j.cgh.2012.05.016

Cordoba J. Hepatic Encephalopathy: From the Pathogenesis to the New Treatments. ISRN Hepatol. 2014;2014:1–16. DOI: 10.1155/2014/236268

Córdoba J. New assessment of hepatic encephalopathy. Journal of hepatology. 2011;54(5):1030-40. DOI: 10.1016/j.jhep.2010.11.015

Bajwa KN, Aziz BI, Nazar TA. Comparison of the effectiveness and safety profile of polyethylene Glycol-Electrolyte solution with lactulose in patients of overt hepatic encephalopathy. Pak J Med Health Sci. 2019;13:411-414.

Reinert JP, Burnham K. Non-Lactulose Medication Therapies for the Management of Hepatic Encephalopathy: A Literature Review. Journal of Pharmacy Practice. 2021;34(6):922-33. DOI: 10.1177/0897190020953024

Als-Nielsen B, Gluud LL, Gluud C. Non-absorbable disaccharides for hepatic encephalopathy: systematic review of randomised trials. BMJ. 2004;328(7447):1046. DOI: 10.1177/0897190020953024

Luo M, Li L, Lu CZ, Cao WK. Clinical efficacy and safety of lactulose for minimal hepatic encephalopathy: A meta-analysis. Eur J Gastroenterol Hepatol. 2011;23(12):1250–57. DOI: 10.1097/MEG.0b013e32834d1938

Liu A, Perumpail RB, Kumari R, Younossi ZM, Wong RJ, Ahmed A. Advances in cirrhosis: Optimizing the management of hepatic encephalopathy. World J Hepatol. 2015;7(29):2871–79. DOI: 10.4254/wjh.v7.i29.2871

Naderian M, Akbari H, Saeedi M, Sohrabpour AA. Polyethylene Glycol and Lactulose versus Lactulose Alone in the Treatment of Hepatic Encephalopathy in Patients with Cirrhosis: A Non-Inferiority Randomized Controlled Trial. Middle East J Dig Dis. 2017;9(1):12-19. DOI: 10.15171/mejdd.2016.46.

Rahimi RS, Singal AG, Cuthbert JA, Rockey DC. Lactulose vs Polyethylene Glycol 3350-Electrolyte Solution for Treatment of Overt Hepatic Encephalopathy: The HELP Randomized Clinical Trial. JAMA Intern Med. 2014;174(11):1727–33. DOI: 10.1001/jamainternmed.2014.4746

Shehata HH, Elfert AA, Abdin AA, Soliman SM, Elkhouly RA, Hawash NI, et al. Randomized controlled trial of polyethylene glycol versus lactulose for the treatment of overt hepatic encephalopathy. Eur J Gastroenterol Hepatol. 2018;30(12):1476–81. DOI: 10.1097/MEG.0000000000001267

Raja WJ, Sebastian B, Mathai SK. To compare the effect of polyethylene glycol vs. lactulose in the treatment ofovert hepatic encephalopathy. Hepatol Gastroint Dis. 2019;5:166.

Ahmed S, Premkumar M, Dhiman RK, Kulkarni A V., Imran R, Duseja A, et al. Combined PEG3350 Plus Lactulose Results in Early Resolution of Hepatic Encephalopathy and Improved 28-Day Survival in Acute-on-Chronic Liver Failure. J Clin Gastroenterol. 2022;56(1):E11–19. DOI: 10.1097/MCG.0000000000001450

Sharma BC, Sharma P, Lunia MK, Srivastava S, Goyal R, Sarin SK. A randomized, double-blind, controlled trial comparing rifaximin plus lactulose with lactulose alone in treatment of overt hepatic encephalopathy. Am J Gastroenterol. 2013;108(9):1458–63. DOI: 10.1038/ajg.2013.219

Lee‐Robichaud H, Thomas K, Morgan J, Nelson RL. Lactulose versus polyethylene glycol for chronic constipation. Cochrane Database of Systematic Reviews. 2010;(7):CD007570. DOI: 10.1002/14651858.CD007570

Attar A, Lémann M, Ferguson A, Halphen M, Boutron MC, Flourié B, et al. Comparison of a low dose polyethylene glycol electrolyte solution with lactulose for treatment of chronic constipation. Gut. 1999;44(2):226–30. DOI: 10.1136/gut.44.2.226

Dhiman RK, Rana B, Agrawal S, Garg A, Chopra M, Thumburu KK, et al. Probiotic VSL#3 reduces liver disease severity and hospitalization in patients with cirrhosis: A randomized, controlled trial. Gastroenterology. 2014;147(6):1327-1337.e3. DOI: 10.1053/j.gastro.2014.08.031

Neff G. Pharmacoeconomics of hepatic encephalopathy. Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy. 2010;30(5P2):28S-32S. DOI: 10.1592/phco.30.pt2.28S

Hoilat GJ, Ayas MF, Hoilat JN, Abu-Zaid A, Durer C, Durer S, Adhami T, John S. Polyethylene glycol versus lactulose in the treatment of hepatic encephalopathy: a systematic review and meta-analysis. BMJ Open Gastroenterology. 2021;8(1):e000648. DOI: 10.1136/bmjgast-2021-000648

Li M, Zhang Z, Chen Q, Zhou X, Shui D, Huang J. Comparative effectiveness and safety of polyethylene glycol electrolyte solution versus lactulose for treatment of hepatic encephalopathy: a systematic review and meta-analysis. Journal of Clinical Gastroenterology. 2022;56(1):41-48. DOI: 10.1097/MCG.0000000000001621

Downloads

Published

2024-07-01

How to Cite

Gnanasekar, V. B., & Veluswamy, S. (2024). An Overview of Polyethylene Glycol with Lactulose as Additional Therapy in the Treatment of Hepatic Encephalopathy. Medical and Pharmaceutical Journal, 3(2), 41–48. https://doi.org/10.55940/medphar202469

Issue

Section

Review articles

Categories