Gluud, LL;
Vilstrup, H;
Morgan, MY;
(2016)
Non-Absorbable Disaccharides for Hepatic Encephalopathy: A Systematic Review and Meta-Analysis.
Hepatology
, 64
(3)
pp. 908-922.
10.1002/hep.28598.
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Abstract
Non-absorbable disaccharides (NADs) have been used to treat hepatic encephalopathy (HE) since 1966. However, a Cochrane review, published in 2004, found insufficient evidence to recommend their use in this context. This updated systematic review evaluates the effects of the NADs, lactulose and lactitol, for the treatment and prevention of HE in patients with cirrhosis. Thirty-eight randomized controlled trials (RCTs), involving 1828 patients, were identified via electronic and manual searches; 31 RCTs looked at the treatment of HE while seven looked at its primary/secondary prevention. Random-effects meta-analyses showed that, compared to placebo/no intervention, NADs had a beneficial effect on HE (relative risk [RR], 0.63; 95% confidence interval [CI], 0.53-0.74; Number Needed to Treat [NNT] = 4) and serious liver-related adverse events such as: liver failure, variceal bleeding, serious infections, spontaneous bacterial peritonitis and hepatorenal syndrome (RR, 0.42; 95% CI, 0.26-0.69; NNT = 50). Treatment was also associated with a reduction in mortality in patients with overt HE (RR, 0.36; 95% CI, 0.14-0.94; NNT = 20), although not in patients with minimal HE. Meta-analyses of the prevention RCTs showed that NADs prevented the development of HE (RR, 0.47; 95% CI, 0.33-0.68; NNT = 6), the risk of developing serious liver-related adverse events (RR, 0.48; 95% CI, 0.33-0.70; NNT = 6), and reduced mortality (RR, 0.63; 95% CI, 0.40-0.98; NNT = 20). Use of NADs was associated with non-serious gastrointestinal adverse events. There were no differences in the efficacy or safety of lactulose and lactitol. CONCLUSIONS: NADs have beneficial effects in the treatment and prevention of HE; their use, in this context, confers additional benefits including a reduction in serious liver-related morbidities and all-cause mortality.
| Type: | Article |
|---|---|
| Title: | Non-Absorbable Disaccharides for Hepatic Encephalopathy: A Systematic Review and Meta-Analysis |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1002/hep.28598 |
| Publisher version: | http://dx.doi.org/10.1002/hep.28598 |
| Language: | English |
| Additional information: | This is the peer reviewed version of the following article: Gluud, LL; Vilstrup, H; Morgan, MY; (2016) Non-Absorbable Disaccharides for Hepatic Encephalopathy: A Systematic Review and Meta-Analysis. Hepatology, which has been published in final form at: http://dx.doi.org/10.1002/hep.28598. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving (http://olabout.wiley.com/WileyCDA/Section/id-828039.html#terms). |
| Keywords: | Adverse events, Efficacy, Lactitol, Lactulose, Randomized controlled trials |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine > Inst for Liver and Digestive Hlth |
| URI: | https://discovery.ucl.ac.uk/id/eprint/1482611 |
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