ReviewEuropean journal of gastroenterology & hepatology2019
Long-term management of hepatic encephalopathy with lactulose and/or rifaximin: a review of the evidence.
Review in European journal of gastroenterology & hepatology, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 41 papers, 2 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.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
41 citing papers in PubMed, 2 syntheses or guidelines pooled it, 87 citations in OpenAlex.
- Efficacy and safety of rifaximin for the prophylaxis of hepatic encephalopathy: A meta-analysis.Medicine · 2025Pooled it
- Rifaximin for prevention and treatment of hepatic encephalopathy in people with cirrhosis.The Cochrane database of systematic reviews · 2023Pooled it
- Effect of a specificWorld journal of hepatology · 2022Trial
- Neuroprotective effects of zingerone on the thioacetamide-induced hepatic encephalopathy in rats. Insights from oxidative stress, ER stress, BDNF signaling and apoptosis.Journal of molecular histology · 2026Article
- Article
- Frequent high-level rifaximin resistance inMicrobiology spectrum · 2025Article
- Protective effects of Fraxinus Micrantha against thioacetamide-induced hepatic encephalopathy: a focus on antioxidant and neuroprotective mechanisms.Metabolic brain disease · 2025Article
- Alcohol-Induced Oxidative Stress and Gut-Liver-Brain Crosstalk: Expanding the Paradigm from ALD to MetALD.Antioxidants (Basel, Switzerland) · 2025Review
- Article
- Development and hepatotoxicity of rifamycin derivatives.Expert opinion on drug metabolism & toxicology · 2025Review
- Therapeutic Duel of Rifaximin Versus Lactulose in Hepatic Encephalopathy: A Systematic Review.Cureus · 2025Review
- Hepatic encephalopathy in cirrhosis: therapies and developments.Metabolic brain disease · 2025Review
- Management of hepatic encephalopathy following transjugular intrahepatic portosystemic shunts: Current strategies and future directions.World journal of gastroenterology · 2025Review
- Real-World Setting of Efficacy and Safety of 3 Years of Rifaximin Administration in Japanese Patients with Hepatic Encephalopathy: A Multicenter Retrospective Study.Journal of clinical medicine · 2025Article
- Small intestinal bacterial overgrowth in chronic liver disease: an updated systematic review and meta-analysis of case-control studies.EClinicalMedicine · 2025Article
- Lactulose-Induced Pneumatosis Intestinalis Causing Sudden Deterioration in a Patient With Advanced Hepatic Disease.Cureus · 2025Article
- Review of history and mechanisms of action of lactulose (4-O-β-D-Galactopyranosyl-β-D-fructofuranose): present and future applications in food.Journal of food science and technology · 2024Review
- A Prospective Multimodal Education Intervention for Providers Does Not Increase Hepatic Encephalopathy Treatment Rates.Digestive diseases and sciences · 2024Article
- Microbiota-gut-liver-brain axis and hepatic encephalopathy.Microbiome research reports · 2024Review
- Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
2 authors at 1 institution in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
A consolidated overview of evidence for the effectiveness and safety/tolerability of hepatic encephalopathy (HE) treatment over the long term is currently lacking. We identified and assessed published evidence for the long-term (≥6 months) pharmacological management of HE with lactulose and/or rifaximin. A literature search was conducted in PubMed (cutoff date 05 March 2018) using the search terms 'hepatic encephalopathy+rifaximin' and 'hepatic encephalopathy+lactulose'. All articles containing primary clinical data were manually assessed to identify studies in which long-term (≥6 months) effectiveness and/or safety/tolerability end points were reported for lactulose and/or rifaximin. Long-term effectiveness outcomes were reported in eight articles for treatment with lactulose alone and 19 articles for treatment with rifaximin, alone or in combination with lactulose. Long-term safety/tolerability outcomes were reported in six articles for treatment with lactulose alone and nine articles for treatment with rifaximin, alone or in combination with lactulose. These studies showed that lactulose is effective for the prevention of overt HE recurrence over the long term and that the addition of rifaximin to lactulose significantly reduces the risk of overt HE recurrence and HE-related hospitalization, compared with lactulose therapy alone, without compromising tolerability. Current evidence therefore supports recommendations for the use of lactulose therapy for the prevention of overt HE recurrence over the long term, and for the additional benefit of adding rifaximin to lactulose therapy. Addition of rifaximin to standard lactulose therapy may result in substantial reductions in healthcare resource utilization over the long term, by reducing overt HE recurrence and associated rehospitalization.
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