24 SPONTANEOUS BACTERIAL PERITONITIS—A CLINICAL STUDY IN CIRRHOTIC PATIENTS WITH ASCITES

Abstract

A b st ra ct s Aim: To study the effects of lactulose and probiotics for secondary prophylaxis of HE. Method: Consecutive cirrhotic patients who recovered from HE were randomized to receive lactulose (Group-L, 30 mL/3 times/day), probiotics (Group-P) three capsules/ day containing 112.5 billion viable lyophilized bacteria per capsule and no therapy (Group-N). All patients were assessed by psychometry (number connection test [NCT-A, B], figure connection test if illiterate [FCT-A, B], digit symbol test (DST), and block design test [BDT]), critical flicker frequency test (CFF) and arterial ammonia at inclusion, and patients were followed up monthly. Development of overt HE was the primary end-point, according to West-Haven criteria or a follow-up of 12 months. Result: Of 360 who recovered, 235 (65.2%) met the inclusion criteria (Group-L, n = 80; Group-P, n = 77 and Group-N, n = 78). Thirty-eight patients (16.1%) were lost to followup. Seventy-seven patients developed HE (Group-L, n = 18; Group-P, n = 22 and Group-N, n = 37). There was significant difference between Group-L vs Group-N (P = 0.001) and between Group-P vs Group-N (P = 0.02) while no difference between Group-L vs Group-P group (P = 0.349). Readmission rate due to causes other than HE (Group-L:Group-P: Group-N, 19:21:28 P = .0.134) and deaths (Group-L: Group-P:Group-N, 13:11:16 P = 0.56) in three groups were similar. There was a high prevalence of abnormal psychometric test results (NCT-A, 71.5%; NCT-B, 69.2%; DST, 76.9%; and BDT, 85.2%). The CFF was < 38 Hz in 118 patients (50.2%). On multivariate analysis, recurrence of overt HE was significantly associated with two or more abnormal psychometric tests and arterial ammonia after the recovery of an episode of HE. Conclusion: Lactulose and probiotics are effective for secondary prophylaxis of HE in patients with cirrhosis.