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Rifaximin And hepatic encephalopathy

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https://www.readbyqxmd.com/read/29762873/l-ornithine-l-aspartate-for-prevention-and-treatment-of-hepatic-encephalopathy-in-people-with-cirrhosis
#1
REVIEW
Ee Teng Goh, Caroline S Stokes, Sandeep S Sidhu, Hendrik Vilstrup, Lise Lotte Gluud, Marsha Y Morgan
BACKGROUND: Hepatic encephalopathy is a common complication of cirrhosis and has high associated morbidity and mortality. The condition is classified as overt if it is clinically apparent or minimal if only evident though psychometric testing. The exact pathogenesis of this syndrome is unknown although ammonia is thought to play a key role. L-ornithine L-aspartate has ammonia-lowering properties and may, therefore, benefit people with cirrhosis and hepatic encephalopathy. OBJECTIVES: To evaluate the beneficial and harmful effects of L-ornithine L-aspartate versus placebo, no intervention, or other active interventions in people with cirrhosis and hepatic encephalopathy...
May 15, 2018: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/29705917/management-of-hepatic-encephalopathy-not-responsive-to-first-line-treatments
#2
REVIEW
Silvia Nardelli, Lorenzo Ridola, Stefania Gioia, Oliviero Riggio
PURPOSE OF REVIEW: Hepatic encephalopathy (HE) is a neuropsychiatric syndrome that occurs in up to 30% of patients with cirrhosis. HE may be a consequence of pure liver failure, as in patients with fulminant hepatitis, or of the combination of liver failure and portal-systemic shunting, as in patients with liver cirrhosis. Episodes of HE are usually related to precipitating events, such as infections or gastrointestinal bleeding; a minority of cirrhotic patients experienced a chronic HE, refractory to standard medical treatment...
April 28, 2018: Current Treatment Options in Gastroenterology
https://www.readbyqxmd.com/read/29651649/systematic-review-of-the-economic-burden-of-overt-hepatic-encephalopathy-and-pharmacoeconomic-impact-of-rifaximin
#3
REVIEW
Guy Neff, Woodie Zachry Iii
BACKGROUND: Hepatic encephalopathy (HE), a common neurologic complication in cirrhosis, is associated with substantial disease and economic burden. Rifaximin is a non-systemic antibiotic that reduces the risk of overt HE recurrence and overt HE-related hospitalizations. OBJECTIVE: Our objective was to provide an overview of the direct HE-related costs and cost benefits of rifaximin, lactulose, and rifaximin plus lactulose. METHODS: A systematic review of PubMed and relevant meeting abstracts was conducted to identify publications since 1 January 2007 reporting economic data related to HE and rifaximin and/or lactulose...
April 12, 2018: PharmacoEconomics
https://www.readbyqxmd.com/read/29644492/update-on-the-therapeutic-management-of-hepatic-encephalopathy
#4
REVIEW
Linda Skibsted Kornerup, Lise Lotte Gluud, Hendrik Vilstrup, Gitte Dam
PURPOSE OF REVIEW: Hepatic encephalopathy (HE) is a common and devastating complication to chronic liver disease. In this paper, we summarize the latest research and evidence of both conventional and up-coming treatments. RECENT FINDINGS: Meta-analyses report beneficial effects of lactulose, branched-chain amino acids, rifaximin, and to some degree L-ornithine L-aspartate on the manifestations of HE in patients with cirrhosis, and generally the numbers needed to treat are low...
April 11, 2018: Current Gastroenterology Reports
https://www.readbyqxmd.com/read/29580065/status-of-rifaximin-a-review-of-characteristics-uses-and-analytical-methods
#5
Ana Carolina Kogawa, Hérida Regina Nunes Salgado
Rifaximin, an oral antimicrobial, has many advantages because it is selective intestine, has minimal adverse effects and is used for the treatment of some diseases such as hepatic encephalopathy, irritable bowel syndrome, travelers' diarrhea, ulcerative colitis, Clostridium difficile and acute diarrhea. Rifaximin in the form of 200 mg tablets is commercially available. The crystalline α form is therapeutically safe and effective. In most of the official compendia, rifaximin has no monograph and in none of them is there a monograph for rifaximin tablets...
March 26, 2018: Critical Reviews in Analytical Chemistry
https://www.readbyqxmd.com/read/29507462/the-burden-of-minimal-hepatic-encephalopathy-from-diagnosis-to-therapeutic-strategies
#6
REVIEW
Lorenzo Ridola, Vincenzo Cardinale, Oliviero Riggio
Minimal hepatic encephalopathy (MHE) is the mildest form of hepatic encephalopathy (HE). It affects the performance of psychometric tests focused on attention, working memory, psychomotor speed, and visuospatial ability, as well as electrophysiological and other functional brain measures. MHE is a frequent complication of liver disease, affecting up to 80% of tested patients. By being related to falls, an impairment in fitness to drive and the development of overt HE, MHE severely affects the lives of patients and caregivers by altering their quality of life and their socioeconomic status...
March 2018: Annals of Gastroenterology: Quarterly Publication of the Hellenic Society of Gastroenterology
https://www.readbyqxmd.com/read/29485654/gut-liver-brain-axis-the-microbial-challenge-in-the-hepatic-encephalopathy
#7
Andrea Mancini, Francesca Campagna, Piero Amodio, Kieran M Tuohy
Hepatic encephalopathy (HE) is a debilitating neuropsychiatric condition often associated with acute liver failure or cirrhosis. Advanced liver diseases are characterized by a leaky gut and systemic inflammation. There is strong evidence that the pathogenesis of HE is linked to a dysbiotic gut microbiota and to harmful microbial by-products, such as ammonia, indoles, oxindoles and endotoxins. Increased concentrations of these toxic metabolites together with the inability of the diseased liver to clear such products is thought to play an important patho-ethiological role...
March 1, 2018: Food & Function
https://www.readbyqxmd.com/read/29457869/assessment-of-the-spectrum-of-hepatic-encephalopathy-a-multicenter-study
#8
Bradley Reuter, Kara Walter, Julien Bissonnette, Michael D Leise, Jennifer Lai, Puneeta Tandon, Patrick S Kamath, Scott W Biggins, Christopher F Rose, James B Wade, Jasmohan S Bajaj
Hepatic encephalopathy (HE) is a major cause of morbidity in cirrhosis. However, its severity assessment is often subjective, which needs to be studied systematically. The aim was to determine how accurately trainee and nontrainee practitioners grade and manage HE patients throughout its severity. We performed a survey study using standardized simulated patient videos at 4 US and 3 Canadian centers. Participants were trainees (gastroenterology/hepatology fellows) and nontrainees (faculty, nurse practitioners, physician assistants)...
May 2018: Liver Transplantation
https://www.readbyqxmd.com/read/29417604/effects-of-alcohol-on-the-brain-in-cirrhosis-beyond-hepatic-encephalopathy
#9
REVIEW
Brian C Davis, Jasmohan S Bajaj
Recent advances have led to a greater understanding of how alcohol alters the brain, both in acute stages (intoxication and alcohol withdrawal) and in chronic misuse. This review focuses on the current understanding of how alcohol affects the brain in cirrhosis patients with and without hepatic encephalopathy (HE). Chronic alcohol use is associated with nutritional deficiencies, dementia, cirrhosis, and decompensating events such as HE. Direct toxicity on brain tissue, induction of neuro-inflammation, and alcohol's alterations of the gut microbiome are possible mechanisms for the clinical features of HE associated with alcohol use...
April 2018: Alcoholism, Clinical and Experimental Research
https://www.readbyqxmd.com/read/29411990/diagnosis-and-management-of-hepatic-encephalopathy
#10
Debbie L Shawcross
Overt and covert hepatic encephalopathy (HE) are debilitating complications of cirrhosis. HE results in a poor quality of life for patients and their caregivers and, unless there is access to liver transplantation, the prognosis is poor. The development of overt HE is often unpredictable, and its management, particularly in the ward, remains challenging. There is an urgent need for novel approaches to treat HE. Until recently, therapies for this complication were disappointing, with frequently intolerable side effects such as diarrhoea and faecal incontinence...
February 7, 2018: British Journal of Nursing: BJN
https://www.readbyqxmd.com/read/29394969/is-lactulose-plus-rifaximin-better-than-lactulose-alone-in-the-management-of-hepatic-encephalopathy
#11
Nauman Ismat Butt, Usman Ismat Butt, Aniqa Anser Tufail Khan Kakar, Tashia Malik, Arif Mahmood Siddiqui
OBJECTIVE: To compare the efficacy of lactulose plus rifaximin with efficacy of lactulose alone in the treatment of hepatic encephalopathy. STUDY DESIGN: A randomized controlled trial. PLACE AND DURATION OF STUDY: Department of Medicine, Jinnah Hospital, Lahore, from December 2014 to June 2015. METHODOLOGY: All patients who presented with hepatic encephalopathy due to decompensated chronic liver disease were randomly divided into two groups of 65 patients each...
February 2018: Journal of the College of Physicians and Surgeons—Pakistan: JCPSP
https://www.readbyqxmd.com/read/29235218/efficacy-and-safety-of-rifaximin-in-japanese-patients-with-hepatic-encephalopathy-a-phase-ii-iii-multicenter-randomized-evaluator-blinded-active-controlled-trial-and-a-phase-iii-multicenter-open-trial
#12
Kazuyuki Suzuki, Ryujin Endo, Yasuhiro Takikawa, Fuminori Moriyasu, Yutaka Aoyagi, Hisataka Moriwaki, Shuji Terai, Isao Sakaida, Yoshiyuki Sakai, Shuhei Nishiguchi, Toru Ishikawa, Hitoshi Takagi, Atsushi Naganuma, Takuya Genda, Takafumi Ichida, Koichi Takaguchi, Katsuhiko Miyazawa, Kiwamu Okita
AIM: The efficacy and safety of rifaximin in the treatment of hepatic encephalopathy (HE) are widely known, but they have not been confirmed in Japanese patients with HE. Thus, two prospective, randomized studies (a phase II/III study and a phase III study) were carried out. METHODS: Subjects with grade I or II HE and hyperammonemia were enrolled. The phase II/III study, which was a randomized, evaluator-blinded, active-comparator, parallel-group study, was undertaken at 37 institutions in Japan...
December 13, 2017: Hepatology Research: the Official Journal of the Japan Society of Hepatology
https://www.readbyqxmd.com/read/29201772/managing-encephalopathy-in-the-outpatient-setting
#13
REVIEW
Tarana Gupta, Sahaj Rathi, Radha K Dhiman
In cirrhosis of liver, hepatic encephalopathy (HE) has an important impact on health-related quality of life. It is important to define whether HE is episodic, recurrent, or persistent; types A, B, or C; overt HE or covert HE; and spontaneous or precipitated. The overt HE is clinically evident and needs hospitalization. Nonabsorbable disaccharides, rifaximin, and probiotics are proven to be useful in the treatment of overt HE. Covert HE includes both minimal HE and grade I HE. It is not apparent on routine clinical examination...
January 2017: Euroasian journal of hepato-gastroenterology
https://www.readbyqxmd.com/read/29201193/effect-of-different-treatments-and-alcohol-addiction-on-gut-microbiota-in-minimal-hepatic-encephalopathy-patients
#14
Zan Zuo, Hong Fan, Xiao-Dan Tang, Yan-Min Chen, Lin-Ting Xun, Yan Li, Zheng-Ji Song, Hui-Qiong Zhai
Minimal hepatic encephalopathy (MHE) is caused by dysbiosis of gut microbiota, particularly the ammonia-producing bacteria. Given the efficacy of certain treatments on MHE and the connection between alcoholism and MHE, a thorough understanding of how these strategies affect the gut microbiota in patients (alcoholic or non-alcoholic) will facilitate the assessment of their efficacy in the reshaping of gut microbiota. In the present study, a metagenomics approach was adopted to reveal alterations in gut microbiota of 14 MHE patients following treatment with rifaximin alone or rifaximin plus probiotics...
November 2017: Experimental and Therapeutic Medicine
https://www.readbyqxmd.com/read/29171503/-prevention-and-treatment-of-hepatic-encephalopathy
#15
Yu P Sivolap
Hepatic encephalopathy is a common neuropsychiatric complication of serious liver diseases and serves as a marker for worsening of their course and increasing the risk of death. The principal pathogenesis factors of hepatic encephalopathy is the excessive formation of ammonia and its accumulation by astrocytes. A key role in the prevention and treatment of hepatic encephalopathy is played by drugs that prevent hyperammonemia and promote the removal of ammonia from the body, namely lactulose, rifaximin and L-ornithine-L-aspartate...
2017: Zhurnal Nevrologii i Psikhiatrii Imeni S.S. Korsakova
https://www.readbyqxmd.com/read/29069372/breakthrough-clostridium-difficile-infection-in-cirrhotic-patients-receiving-rifaximin
#16
Elena Reigadas, Luis Alcalá, Javier Gómez, Mercedes Marín, Adoración Martin, Raffaella Onori, Patricia Muñoz, Emilio Bouza
Background: Patients with cirrhosis are at high risk of Clostridium difficile infection (CDI). Rifaximin is commonly used in cirrhotic patients as prophylaxis for hepatic encephalopathy (HE). Several studies have demonstrated the efficacy of rifaximin in the treatment of CDI; however, resistance to rifaximin has also been reported. Few studies have assessed the risk of developing CDI in cirrhotic patients receiving rifaximin. Our objective was to assess the incidence and characteristics of CDI in patients with cirrhosis, especially in those who received rifaximin...
March 19, 2018: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
https://www.readbyqxmd.com/read/29067149/the-impact-of-rifaximin-%C3%AE-on-the-hospital-resource-use-associated-with-the-management-of-patients-with-hepatic-encephalopathy-a-retrospective-observational-study-impress
#17
Mark Hudson, Amr Radwan, Paola Di Maggio, Riccardo Cipelli, Stephen D Ryder, John F Dillon, William Jonathan Cash, Robert T Przemioslo, Mark Wright, Debbie L Shawcross, Rajiv Jalan, Sushma Saksena, Michael Allison, Paul Richardson, Elizabeth Farrington, Richard J Aspinall
OBJECTIVE: To compare all-cause and liver-related hospital resource use in the 6 and 12 months pre-rifaximin-α and post-rifaximin-α initiation in UK patients with hepatic encephalopathy (HE). DESIGN: A UK multicentre, retrospective, observational study. Patients' medical records were reviewed for demographics, clinical outcomes and adverse events (AEs) to rifaximin-α. Details of hospital admissions/attendances in the 6 and 12 months pre-rifaximin-α and post-rifaximin-α initiation were extracted from hospital electronic databases...
October 2017: Frontline Gastroenterology
https://www.readbyqxmd.com/read/29026340/economic-impact-of-the-use-of-rifaximin-550-mg-twice-daily-for-the-treatment-of-overt-hepatic-encephalopathy-in-italy
#18
Daniela Paola Roggeri, Alessandro Roggeri
PURPOSE: Hepatic encephalopathy (HE) is associated with a reduced survival, an increased risk of hospitalization for recurrences, and a reduced health-related quality of life. The purpose of the present economic analysis was to evaluate the impact on the Italian National Health Service (INHS) expenditure of the treatment with rifaximin 550 mg twice daily (Tixteller® /Tixtar® ) for the reduction of the recurrences of overt HE, with respect to the current treatment approach. PATIENTS AND METHODS: Costs associated with patients treated with rifaximin 550 mg twice daily were estimated considering the reduction in hospitalizations for HE recurrences revealed by registrative clinical trial (-50%) applied to the hospitalization rate (42...
2017: Hepatic Medicine: Evidence and Research
https://www.readbyqxmd.com/read/29020023/the-continuous-reaction-time-test-for-minimal-hepatic-encephalopathy-validated-by-a-randomized-controlled-multi-modal-intervention-a-pilot-study
#19
RANDOMIZED CONTROLLED TRIAL
M M Lauridsen, S Mikkelsen, T Svensson, J Holm, C Klüver, J Gram, H Vilstrup, O B Schaffalitzky de Muckadell
BACKGROUND: Minimal hepatic encephalopathy (MHE) is clinically undetectable and the diagnosis requires psychometric tests. However, a lack of clarity exists as to whether the tests are in fact able to detect changes in cognition. AIM: To examine if the continuous reaction time test (CRT) can detect changes in cognition with anti-HE intervention in patients with cirrhosis and without clinically manifest hepatic encephalopathy (HE). METHODS: Firstly, we conducted a reproducibility analysis and secondly measured change in CRT induced by anti-HE treatment in a randomized controlled pilot study: We stratified 44 patients with liver cirrhosis and without clinically manifest HE according to a normal (n = 22) or abnormal (n = 22) CRT...
2017: PloS One
https://www.readbyqxmd.com/read/28982166/emergence-of-rifampin-resistant-staphylococci-after-rifaximin-administration-in-cirrhotic-patients
#20
Ji Young Chang, Seong-Eun Kim, Tae Hun Kim, So-Youn Woo, Min Sun Ryu, Yang-Hee Joo, Ko Eun Lee, Jihyun Lee, Kang Hoon Lee, Chang Mo Moon, Hye-Kyung Jung, Ki-Nam Shim, Sung-Ae Jung
OBJECTIVES: Rifaximin, a poorly absorbed antibiotics, has gut-specific therapeutic effects. Although frequently prescribed to manipulate intestinal luminal bacterial population in various diseases, the possible induction of antibacterial cross-resistance to a target pathogen is a major concern in long-term rifaximin administration. We aimed to evaluate whether rifampin-resistant staphylococci could evolve after rifaximin treatment in cirrhotic patients. METHOD: A total of 25 cirrhotic patients who were administered rifaximin for the prevention of hepatic encephalopathy were enrolled...
2017: PloS One
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