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Academic literature on the topic 'Hepatic encephalopathy PEG Lactulose HESA'
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Journal articles on the topic "Hepatic encephalopathy PEG Lactulose HESA"
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Hoilat, Gilles Jadd, Mohamad Fekredeen Ayas, Judie Noemie Hoilat, et al. "Polyethylene glycol versus lactulose in the treatment of hepatic encephalopathy: a systematic review and meta-analysis." BMJ Open Gastroenterology 8, no. 1 (2021): e000648. http://dx.doi.org/10.1136/bmjgast-2021-000648.
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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<0.001), a higher proportion of patients with reduction of HESA Score by ≥1 grade at 24 hours (risk ratio (RR)=1.40, 95% CI (1.17 to 1.67), p<0.001), a higher proportion of patients with a HESA Score of grade 0 at 24 hours (RR=4.33, 95% CI (2.27 to 8.28), p<0.0010) and a shorter time to resolution of HE group (MD=−1.45, 95% CI (−1.72 to –1.18), p<0.001) in favour of patients treated with PEG.ConclusionPEG leads to a higher drop in the HESA Score and thus leads to a faster resolution of HE compared with lactulose.
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Afzaal, T., C. J. Karvellas, and J. Dionne. "A227 THE EFFECTIVENESS OF PEG 3350 COMPARED TO LACTULOSE FOR THE TREATMENT OF ACUTE HEPATIC ENCEPHALOPATHY IN ADULT CIRRHOTIC PATIENTS: A SYSTEMATIC REVIEW AND META-ANALYSIS." Journal of the Canadian Association of Gastroenterology 5, Supplement_1 (2022): 118–19. http://dx.doi.org/10.1093/jcag/gwab049.226.
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Abstract Background Cirrhosis is the leading cause of liver-related death globally. Hepatic encephalopathy (HE) leads to significant morbidity and mortality. Lactulose is the current gold standard treatment for HE; it eliminates nitrogenous waste from the gut. Polyethylene glycol 3350–electrolyte solution (PEG) is a safe, common and effective purgative with recent studies suggesting its efficacy resulting in faster resolution of HE and shorter hospital length of stay. Aims To assess the efficacy and safety of PEG 3350 compared to lactulose in adult cirrhotic patients 18 years of age and older with overt hepatic encephalopathy on patient important outcomes including: improvement of hepatic encephalopathy, hospital length of stay and mortality. Methods We reviewed databases MEDLINE, EMBASE, OVID, CINAHL, Cochrane Database, PubMed, Trip database, the grey literature, and clinicaltrials.gov from inception to December 2020: PROSPERO CRD42021257641. Search strategy was developed in conjunction with medical librarian. Randomized controlled trials (RCTs), either published or non-published, were included in the review. Continuous data was analyzed using mean difference with random-effects model. Dichotomous data was analyzed using the Mantel-Haenszel method using random-effects model. Statistical effect-size heterogeneity was assessed using Chi2 test and quantifying the relative proportion of variation using I2 statistic. The overall certainty of evidence will be assessed using the Grading of Recommendations, Assessment, Development and Evaluations system (GRADE). Results From the 68 studies, 16 were assessed for full text review from which 5 studies were included in the meta-analysis representing a total of 351 patients. The primary outcome of mean change in Hepatic Encephalopathy Scoring Algorithm (HESA) at 24-hours from baseline demonstrated an improvement in the PEG group compared to lactulose group [Mean difference (MD)= 0.60, 95% CI (0.20, 1.01)]. In comparison to lactulose, PEG also demonstrated a shorter hospital length of stay [MD = -1.00, 95% CI (-1.99, -0.01)], shorter time to HE resolution [MD= -1.49, 95% CI (-1.81, -1.16)] and showed a mortality benefit [RR=0.35, 95% CI (0.13 to 0.92)]. There was no significant difference between change in ammonia levels at 24 hours [MD= -25.80, 95% CI (-95.39, 43.78)]. Conclusions PEG leads to a faster improvement and resolution of HE when compared to the current standard of care, lactulose. Funding Agencies None
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Tahir, Furqan, Irfan Younus, Zaid Gul, Adnan Qadir, Muhammad Bilal, and Talha Firoz. "Comparison of Efficacy of Lactulose with and without Polyethylene Glycol in the Treatment of Patients with Hepatic Encephalopathy." Pakistan Journal of Medical and Health Sciences 17, no. 2 (2023): 258–60. http://dx.doi.org/10.53350/pjmhs2023172258.
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Objective: To compare the effectiveness of the combination of Lactulose and Polyethylene glycol (PEG) versus Lactulose alone in improving the grade of hepatic encephalopathy (HE) within 24 hours of hospital admission in patients with hepatic encephalopathy due to decompensated liver cirrhosis precipitated by constipation. Study Design: Randomized controlled trial. Place and Duration: The Department of Gastroenterology, Hepatology and GI Endoscopy, Shaheed Zulfiqar Ali Bhutto Medical University, Pakistan Institute of Medical Sciences (PIMS), Islamabad, Pakistan from 07-05-2020 to 06-05-2021. Methodology: One hundred and sixteen patients (58 in each group) of either gender aged 20-70 years having decompensated liver cirrhosis with HE grade 2 to 4 secondary to constipation were enrolled. Patients were randomly and equally divided into either Lactulose and PEG (Group-1) or Lactulose alone (Group-2) by lottery method. West Haven Criteria was used for labeling HE grades at the baseline and after 24 hours of treatment in both study groups. A one-grade improvement in HE after 24 hours of treatment from the baseline was considered as effectiveness of treatment. Results: Treatment was found effective (at least one HE grade improvement) in 43 (74.1%) patients treated with PEG+Lactulose, while it was 32 (55.2%) in patients who were treated with Lactulose alone (p=0.033). When stratified for age and gender, PEG+Lactulose was significantly effective in improving HE grades in younger age group (p=0.007) and males (p=0.040). Practical Implications: Combination treatment with PEG+Lactulose can be a preferred option for improvement in HE grades in comparison to treatment with lactulose alone Conclusions: Combination treatment with PEG+Lactulose was found to be more effective in improving HE grades when compared to treatment with lactulose alone within 24 hours of hospital admission among patients who had decompensated liver cirrhosis precipitated by constipation. Keywords: Constipation, decompensated liver disease, Hepatic encephalopathy, Lactulose, Polyethylene glycol.
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Gnanasekar, Vishnu Bagavath, and Sivakumar Veluswamy. "An Overview of Polyethylene Glycol with Lactulose as Additional Therapy in the Treatment of Hepatic Encephalopathy." Medical and Pharmaceutical Journal 3, no. 2 (2024): 41–48. http://dx.doi.org/10.55940/medphar202469.
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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.
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Gnanasekar, Vishnu Bagavath, and Sivakumar Veluswamy. "An Overview of Polyethylene Glycol with Lactulose as Additional Therapy in the Treatment of Hepatic Encephalopathy." Medical and Pharmaceutical Journal 3, no. 2 (2024): 41–48. https://doi.org/10.55940/medphar202471.
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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.
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Mounsey, Anne. "PEG in place of lactulose for treatment of acute hepatic encephalopathy." Evidence-Based Practice 18, no. 6 (2015): 4. http://dx.doi.org/10.1097/01.ebp.0000540977.84795.3e.
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Afzaal, Tamoor, Abigail Mazurek, Yuhong Yuan, Kaitryn Campbell, Constantine J. Karvellas, and Joanna C. Dionne. "Su1555 THE EFFECTIVENESS OF PEG 3350 COMPARED TO LACTULOSE FOR THE TREATMENT OF ACUTE HEPATIC ENCEPHALOPATHY IN ADULT CIRRHOTIC PATIENTS: A SYSTEMATIC REVIEW AND META-ANALYSIS." Gastroenterology 164, no. 6 (2023): S—1329. http://dx.doi.org/10.1016/s0016-5085(23)04094-5.
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Bastawy, Mohamed, Sayed Gaber та Ahmed Abdelalim. "Evaluation of Polyethylene Glycol 4000 Solution (PEG) Efficacy versus Lactulose in Treatment of Hepatic Encephalopathy = تقييم فاعلية محلول البولي إيثيلين جلايكول 4000 مقارنة باللاكتيلوز في مناجزة الإعتلال الكبدي الدماغي". Al-Azhar Medical Journal 45, № 3 (2016): 585–94. http://dx.doi.org/10.12816/0033125.
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Waseem, Raja Rohey Jan, Sebastian Sunil K. Mathai Benoy, and Ashfaq. "TO COMPARE THE EFFECT OF POLYETHYLENE GLYCOL VS LACTULOSE IN THE TREATMENT OF OVERT HEPATIC ENCEPHALOPATHY." April 5, 2019. https://doi.org/10.5281/zenodo.2900074.
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Inroduction :Hepatic encephalopathy is one of the most common cause of hospitalization for cirrhotic patients.. Lactulose has long been used as the standard therapy for the treatment of acute HE . This study evaluated the efficacy of PEG as compared with lactulose for the initial treatment of HE. Aims & Objective: (1) To compare efficacy of PEG 3350 electrolyte solution over lactulose in patients admitted for hepatic encephalopathy. (2) To determine whether treatment with PEG will reduce duration of hospital stay ,and whether PEG can be an effective additional treatment option for HE. Material &Methods:This Prospective , randomized , Comparative study was conducted in the Department of Gastroenterology Medical Trust hospital , Kochi ? Kerala India , over a period of two year from May 2015 ? April 2017 following its approval by the Institutional ethical committee . 50 patients with cirrhosis and altered mental status attributed to HE were randomized to a standard lactulose protocol or a PEG protocol ( 25 in each group ) . Interventions :Patients in the PEG group (n =25 ) received 2 L of PEG orally or via NG tube as a single dose over 4 hours. Patients in the lactulose group (n=25) received 20 - 30 g lactulose orally or via NG tube for 3 or more doses over 24 hours, or a single dose of 200 g lactulose via rectal tube. Grade of HE was determined prior to treatment and again at 24 hours using the hepatic encephalopathy scoring algorithm (HESA). After 24 hours, all patients received lactulose per the standard of care . Main Outcomes And Measures : The primary end point was an improvement of 1 or more in HE grade at 24 hours, determined using the hepatic encephalopathy scoring algorithm (HESA), ranging from 0 (normal clinical and neuropsychological assessments) to 4 (coma). Secondary outcomes included time to HE resolution and overall length of stay. Results : In our study , the gender distribution among two study groups showed a male predominant . Majority of HE patients were found in age group of 55-64 years. The most common underlying etiology of Liver Cirrhosis was Alcoholic liver disease 70% ,Cryptogenic 14% , followed by Hepatitis C. The most common precipitant for Hepatic encephalopathy was GI Bleeding , followed by Constipation and Sepsis. The two groups were comparable in terms of baseline laboratory parameters . All patients were of Child Turcot Pugh (CTP ) class C , with a Mean MELD score of 19.08 ? 2.23 in PEG group vs 18.76 ?2.36 in Lactulose group ( P value = 0.625, NS) . Majority of the patients were in grade 3 encephalopathy 58% (29/50 ) , followed by grade 2 in 32 % ( 16/50 ) at the time of presentation .A significant difference was seen between two groups in terms of mean change in grade of encephalopathy ( HESA score ) after 24 hours of therapy , with 1.00 ? 1.04 in PEG group compared to 1.76 ? 0.87 in lactulose group , with a significant P value of < 0.007 . A significant difference between two groups in terms of mean time taken for complete resolution of hepatic encephalopathy , with 2.12 ? 0.52 days in PEG group compared to 3.76 ? 1.05 days in Lactulose group , with a significant P value of <0.001 , However there was no significant difference in length of hospital stay between two groups , with a mean hospital stay of 8.32 ? 1.77 days in PEG group compared to 8.28 ? 1.51 days in Lactulose group , with a ( P value = 0.93) .There was no significant difference in terms of mean change in serum ammonia level , serum Na+ and K+ after 24 hours, between the treatment groups Overall , treatment regimens were similar in terms of tolerability , with the exception that in the lactulose arm, there was more bloating , while PEG patients experienced more of diarrheal symptoms. Conclusions:PEG led to more rapid HE resolution than standard therapy, As compared with lactulose alone, the use of PEG alone during the first 24 hours of presentation worked better at improving symptoms of HE. The benefit beyond this time is less clear as both groups in this study received lactulose after 24 hours .