Polyethylene Glycol for Hepatic Encephalopathy

Abstract

the patient’s dose of lactulose until a minimum of 2 to 3 bowel movements have occurred. Second, patients treated with combined lactulose and rifaximin were excluded. Rifaximin is an effective, widely used addition to lactulose regimens, and it is possibly better tolerated than the high-volume PEG solution over 4 hours. Increasing the patient population with an additional rifaximin-lactulose arm would offer further insight into currently accepted therapies and the potential role of PEG. Finally, this study focused on the treatment of acute encephalopathy alone, whereas the major treatment challenge remains refractory symptoms. While this study shows good effect in the acute setting, the potential role of PEG electrolyte solution in long-term therapy is unclear. However, this opens the possible role of daily PEG and other bowel-purging therapies. This study offers a glimpse into advances in managing acute hepatic encephalopathy and challenges the notion of the role of complex gut biochemistry in the disease. The role of ammonia continues to be debated. A recent review 5 suggested that increased ammonia levels might be the root cause of hepatic encephalopathy. A number of agents interfere with ammoniagenesis, including sodium phenylbutyrate and sodium benzoate, and have been proposed as potential treatments for hepatic encephalopathy (Table). Compared with PEG, however, these agents remain expensive and less well studied.