Brief Article
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World J Gastroenterol. Feb 28, 2012; 18(8): 767-777
Published online Feb 28, 2012. doi: 10.3748/wjg.v18.i8.767
Rifaximin vs conventional oral therapy for hepatic encephalopathy: A meta-analysis
Karim M Eltawil, Marie Laryea, Kevork Peltekian, Michele Molinari
Karim M Eltawil, Michele Molinari, Department of Surgery and Transplantation, Queen Elizabeth II Health Sciences Center, Dalhousie University, Halifax, Nova Scotia B3H 2Y9, Canada
Marie Laryea, Kevork Peltekian, Department of Medicine, Hepatology and Transplantation, Queen Elizabeth II Health Sciences Center, Dalhousie University, Halifax, Nova Scotia B3H 2Y9, Canada
Author contributions: Eltawil KM and Molinari M contributed equally to this work; Eltawil KM performed the systematic literature review, contributed to the appraisal of the literature, performed the analysis and wrote the paper; Molinari M performed the systematic literature review, contributed to the appraisal of the literature, performed the analysis and wrote the paper; Laryea M and Peltekian K contributed to the design framework of the manuscript.
Correspondence to: Michele Molinari, MD, Department of Surgery and Transplantation, Queen Elizabeth II Health Sciences Center, Dalhousie University, Rm 6-254, Victoria Building, 1276 South Park Street, Halifax, Nova Scotia B3H 2Y9, Canada. michele.molinari@cdha.nshealth.ca
Telephone: +1-902-4737624 Fax: +1-902-4737639
Received: April 29, 2011
Revised: June 16, 2011
Accepted: June 23, 2011
Published online: February 28, 2012
Abstract

AIM: To characterize the efficacy of rifaximin in the management of hepatic encephalopathy (HE) as several randomized controlled studies have shown contradictory results on its effectiveness in comparison to other oral agents.

METHODS: We performed a systematic review and random effects meta-analysis of all eligible trials identified through electronic and manual searches. Twelve randomized controlled trials met the inclusion criteria with a total of 565 patients.

RESULTS: The clinical effectiveness of rifaximin was equivalent to disaccharides or other oral antibiotics [odds ratio (OR) 0.96; 95% CI: 0.94-4.08] but with a better safety profile (OR 0.27; 95% CI: 0.12-0.59). At the completion of treatment protocols, patients receiving rifaximin showed lower serum ammonia levels [weighted mean difference (WMD) = -10.65; 95% CI: -23.4-2.1; P = 0.10], better mental status (WMD = -0.24; 95% CI: -0.57-0.08; P = 0.15) and less asterixis (WMD -0.1; 95% CI -0.26-0.07; P = 0.25) without reaching statistical significance. On the other hand, other psychometric outcomes such as electroencephalographic response and grades of portosystemic encephalopathy were superior in patients treated with rifaximin in comparison to the control group (WMD = 0.21, 95% CI: -0.33-0.09, P = 0.0004; and WMD = -2.33, 95% CI: -2.68-1.98, P = 0.00001, respectively). Subgroup and sensitivity analysis did not show any significant difference in the above findings.

CONCLUSION: Rifaximin appears to be at least as effective as other conventional oral agents for the treatment of HE with a better safety profile.

Keywords: Hepatic encephalopathy; Lactulose; Neomycin; Non-absorbable disaccharides; Rifaximin