SynthesisBMJ (Clinical research ed.)2004
Non-absorbable disaccharides for hepatic encephalopathy: systematic review of randomised trials.
Synthesis in BMJ (Clinical research ed.), 2004. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 2 registered trials, which are not on this map. Cited by 80 papers, 5 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Efficacy of Intravenous 'L-ornithine L-aspartate' in Reversal of Overt Acute Hepatic Encephalopathy in Patients With Liver Cirrhosis: a Prospective, Randomized, Double-blind, Placebo Controlled Trial
Plasma Free Amino Acids in Patients With Hepatic Encephalopathy and Its Impact on Disease Outcomes.
Who cites it
80 citing papers in PubMed, 5 syntheses or guidelines pooled it, 368 citations in OpenAlex.
- Combination therapy with rifaximin and lactulose in hepatic encephalopathy: A systematic review and meta-analysis.PloS one · 2022Pooled it
- KASL clinical practice guidelines for liver cirrhosis: Varices, hepatic encephalopathy, and related complications.Clinical and molecular hepatology · 2020Guideline
- Non-absorbable disaccharides versus placebo/no intervention and lactulose versus lactitol for the prevention and treatment of hepatic encephalopathy in people with cirrhosis.The Cochrane database of systematic reviews · 2016Pooled it
- Revision and update on clinical practice guideline for liver cirrhosis.The Korean journal of hepatology · 2012Guideline
- Rifaximin vs. conventional oral therapy for hepatic encephalopathy: a meta-analysis.World journal of gastroenterology · 2012Pooled it
- Effect of a specificWorld journal of hepatology · 2022Trial
- Role of lactulose for prophylaxis against hepatic encephalopathy in cirrhotic patients with upper gastrointestinal bleeding: A randomized trial.Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology · 2021Trial
- Which of the branched-chain amino acids increases cerebral blood flow in hepatic encephalopathy? A double-blind randomized trial.NeuroImage. Clinical · 2018Trial
- Erythromycin versus neomycin in the treatment of hepatic encephalopathy in cirrhosis: a randomized double-blind study.BMC gastroenterology · 2013Trial
- Effects of L-acetylcarnitine on cirrhotic patients with hepatic coma: randomized double-blind, placebo-controlled trial.Digestive diseases and sciences · 2006Trial
- Comparison of rifaximin and lactulose for the treatment of hepatic encephalopathy: a prospective randomized study.Yonsei medical journal · 2005Trial
- Flapping Tremor: Unraveling Asterixis-A Narrative Review.Medicina (Kaunas, Lithuania) · 2024Review
- Hepatic Encephalopathy following Transjugular Intrahepatic Portosystemic Shunt Placement.Seminars in interventional radiology · 2023Review
- Real-world evidence of long-term survival and healthcare resource use in patients with hepatic encephalopathy receiving rifaximin-α treatment: a retrospective observational extension study with long-term follow-up (IMPRESS II).Frontline gastroenterology · 2023Article
- Efficacy of Switching from Kanamycin Sulfate to Rifaximin in Patients with Hepatic Cirrhosis.Internal medicine (Tokyo, Japan) · 2021Article
- Step by Step: Managing the Complications of Cirrhosis.Hepatic medicine : evidence and research · 2021Review
- Retrograde Transvenous Obliteration (RTO): A New Treatment Option for Hepatic Encephalopathy.Digestive diseases and sciences · 2020Review
- Recent advances in understanding and managing hepatic encephalopathy in chronic liver disease.F1000Research · 2020Review
- Current and future pharmacological therapies for managing cirrhosis and its complications.World journal of gastroenterology · 2019Review
- Biological Activities of Lactose-Derived Prebiotics and Symbiotic with Probiotics on Gastrointestinal System.Medicina (Kaunas, Lithuania) · 2018Review
20 more citing papers are in PubMed but not listed here.
Corrections and comments
- Commented on by
Authors and funding
3 authors at 3 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo assess the effects of non-absorbable disaccharides (lactulose and lactitol) in patients with hepatic encephalopathy. DATA SOURCES: Cochrane Hepato-Biliary Group controlled trials register, Cochrane Library, Medline, and Embase until March 2003; reference lists of relevant articles; authors and pharmaceutical companies. REVIEW
methodsRandomised trials that compared non-absorbable disaccharides with placebo, no intervention, or antibiotics for hepatic encephalopathy were included. The primary outcome measures were no improvement of hepatic encephalopathy and all cause mortality.
results22 trials were included. Compared with placebo or no intervention, non-absorbable disaccharides seemed to reduce the risk of no improvement in patients with hepatic encephalopathy (relative risk 0.62, 95% confidence interval 0.46 to 0.84, six trials). However, high quality trials found no significant effect (0.92, 0.42 to 2.04, two trials). Compared with placebo or no intervention, non-absorbable disaccharides had no significant effect on mortality (0.41, 0.02 to 8.68, four trials). Non-absorbable disaccharides were inferior to antibiotics in reducing the risk of no improvement (1.24, 1.02 to 1.50, 10 trials) and lowering blood ammonia concentration (weighted mean difference 2.35 micromol/l, 0.06 micromol/l to 13.45 micromol/l, 10 trials). There was no significant difference in mortality (0.90, 0.48 to 1.67, five trials).
conclusionsThere is insufficient evidence to support or refute the use of non-absorbable disaccharides for hepatic encephalopathy. Antibiotics were superior to non-absorbable disaccharides in improving hepatic encephalopathy, but it is unclear whether this difference is clinically important. Non-absorbable disaccharides should not serve as comparator in randomised trials on hepatic encephalopathy.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.