Pharmacological prophylaxis of hepatic encephalopathy after transjugular intrahepatic portosystemic shunt: a randomized controlled study

• Published in: Journal of hepatology Vol. 42; no. 5; pp. 674 - 679
• Main Authors: Riggio, O., Masini, A., Efrati, C., Nicolao, F., Angeloni, S., Salvatori, Filippo M., Bezzi, M., Attili, Adolfo F., Merli, M.
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier B.V 01-05-2005; Elsevier
• Subjects: Adult; Aged; Biological and medical sciences; Cathartics - administration & dosage; Female; Gastroenterology. Liver. Pancreas. Abdomen; Gastrointestinal Agents - administration & dosage; Hepatic encephalopathy; Hepatic Encephalopathy - epidemiology; Hepatic Encephalopathy - prevention & control; Humans; Incidence; Liver cirrhosis; Liver Cirrhosis - drug therapy; Liver Cirrhosis - epidemiology; Liver Cirrhosis - surgery; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Male; Medical sciences; Middle Aged; Other diseases. Semiology; Portal hypertension; Portasystemic Shunt, Transjugular Intrahepatic; Postoperative Complications - epidemiology; Postoperative Complications - prevention & control; Rifamycins - administration & dosage; Sugar Alcohols - administration & dosage; TIPS; Treatment Failure; Liver cirrhosis; Hepatic encephalopathy; Portal hypertension; TIPS; Portal circulation disease; Cardiovascular disease; Hepatic disease; Intrahepatic portosystemic shunt; Vascular disease; Prevention; Cirrhosis; Liver failure; Digestive diseases
• ISSN: 0168-8278; 1600-0641
• DOI: 10.1016/j.jhep.2004.12.028

Hepatic encephalopathy is a frequent event after transjugular-intrahepatic-portosystemic-shunt (TIPS), especially during the first months. Aim of this study was to compare two different treatments (lactitol 60
g/day, rifaximin 1200
mg/day) with no-treatment in the prevention of post-TIPS hepatic encephalopathy.
Seventy-five consecutive cirrhotics submitted to TIPS were randomized to receive either one of the above treatments or no-treatment. The main end-point was the occurrence of an episode of overt hepatic encephalopathy during the first month post-TIPS. Before the procedure and weekly thereafter the patients were evaluated by examining their mental status, asterixis, ammonia and trail-making-test Part-A (TMT-A).
The three groups were comparable for age, sex, etiology, Child-Pugh-score, post-TIPS porto-systemic gradient, previous hepatic encephalopathy, basal values of ammonia and psychometric performance. Twenty-five patients developed hepatic encephalopathy (33%, CI 95%=22–45%). One-month incidence was similar in the three groups (
P=0.97). Previous hepatic encephalopathy (Relative Hazard=3.79;1.27–11.31) and basal-TMT-A
Z-score>1.5 (RH=3.55;1.24–10.2) were predictors of post-TIPS encephalopathy at multivariate analysis. A <5
mmHg porto-systemic gradient was also significantly related to the occurrence of encephalopathy.
Our data show that treatment with lactitol or rifaximin is not effective in the prophylaxis of hepatic encephalopathy during the first month after a TIPS.