Polyethylene glycol versus lactulose in the treatment of hepatic encephalopathy: a systematic review and meta-analysis

• Published in: BMJ open gastroenterology Vol. 8; no. 1; p. e000648
• Main Authors: Hoilat, Gilles Jadd, Ayas, Mohamad Fekredeen, Hoilat, Judie Noemie, Abu-Zaid, Ahmed, Durer, Ceren, Durer, Seren, Adhami, Talal, John, Savio
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 18-05-2021; BMJ Publishing Group
• Subjects: Bias; Brain research; Hepatology; Intervention; Liver cirrhosis; Meta-analysis; Pathogenesis; Polyethylene glycol; Sensitivity analysis; Software; Systematic review; India; cirrhosis; hepatic encephalopathy; lactulose
• ISSN: 2054-4774; 2054-4774
• DOI: 10.1136/bmjgast-2021-000648

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.