ABSTRACT

Objective: To find out the incidence of hepatic encephalopathy (HE) in cirrhosis patients with spontaneous bacterial peritonitis receiving lactulose and lactulose/rifaximin in combination and to compare the efficacy of either regimen.
Study Design: Cross-sectional study.
Place and Duration of Study: The Study was conducted at the Department of Medicine, Pak Emirates Military Hospital, Rawalpindi, Pakistan, from September 2021 to August 2022.
Methods: Using consecutive sampling, diagnosed cases of decompensated Chronic Liver Disease with clinically apparent ascites, visiting the outpatient department, with or without signs and symptoms of spontaneous bacterial peritonitis (SBP) were included in the study after laboratory confirmation of spontaneous bacterial peritonitis (SBP). The drug history was taken, and Hepatic encephalopathy was diagnosed using Mini-mental Scale Examination and West-Haven criteria. The incidence of hepatic encephalopathy (HE) was compared across the groups using the Pearson Chi-square test.
Results: A total of 60 diagnosed Chronic liver disease patients with spontaneous bacterial peritonitis (SBP) were included in the study. Rifaximin was being used by 41.7% (n=25), 41.7% (n=25) patients were using lactulose alone and 16.7% (n=10) were using a combination of both drugs. 58.3% (n=35) of patients were found to have hepatic encephalopathy (HE). Out of these, 42.8% (n=15) were using rifaximin alone, 54.2% (n=19) were using lactulose alone, while just 2% (n=1) patients were using the combination of both drugs (P < 0.001).
Conclusion: Spontaneous Bacterial Peritonitis is an important trigger of Hepatic Encephalopathy  in the setting of decompensated chronic liver disease and is associated with high mortality. The use of lactulose and rifaximin combination is superior to monotherapy with either of them for preventing Hepatic Encephalopathy in these patients.

Keywords: Ascites, Decompensated Chronic Liver Disease, Hepatic Encephalopathy, Lactulose, Rifaximin, Spontaneous Bacterial Peritonitis.

How to cite this: Aziz MS, Siddiqi FA, Hammad M, Anwar W, Aman S. Incidence of Hepatic Encephalopathy in Patients with Spontaneous Bacterial Peritonitis Using Rifaximin and Lactulose: A Study at a Tertiary Care Hospital in Rawalpindi. Life and Science. 2024; 5(3): 311-316. doi: http://doi.org/10.37185/LnS.1.1.374