SynthesisDrug design, development and therapy2019
Combination of rifaximin and lactulose improves clinical efficacy and mortality in patients with hepatic encephalopathy.
Synthesis in Drug design, development and therapy, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 21 papers, 3 of them syntheses that pooled it.
What it found
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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
21 citing papers in PubMed, 3 syntheses or guidelines pooled it, 44 citations in OpenAlex.
- Preventive and therapeutic effects of rifaximin on hepatic encephalopathy with differential application dosages and strategies: a network meta-analysis.BMC gastroenterology · 2024Pooled it
- Rifaximin for prevention and treatment of hepatic encephalopathy in people with cirrhosis.The Cochrane database of systematic reviews · 2023Pooled it
- Combination therapy with rifaximin and lactulose in hepatic encephalopathy: A systematic review and meta-analysis.PloS one · 2022Pooled it
- Quality of Life in Patients with Hepatic Encephalopathy Treated with Rifaximin: A Systematic Review.Journal of clinical medicine · 2026Review
- A Novel Use of Tenapanor in Patients With Hepatic Encephalopathy: A Case Series.ACG case reports journal · 2026Article
- Lactulose, Rifaximin, and Survival in Hepatic Encephalopathy: A Cohort Study of 120 Patients.Journal of clinical medicine · 2025Article
- Therapeutic Duel of Rifaximin Versus Lactulose in Hepatic Encephalopathy: A Systematic Review.Cureus · 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
- A Prospective Multimodal Education Intervention for Providers Does Not Increase Hepatic Encephalopathy Treatment Rates.Digestive diseases and sciences · 2024Article
- Navigating the Labyrinth: Intensive Care Challenges for Patients with Acute-on-Chronic Liver Failure.Journal of clinical medicine · 2024Review
- Review
- The contributions of bacteria metabolites to the development of hepatic encephalopathy.Liver research (Beijing, China) · 2023Article
- Rifaximin Use, Adherence and Persistence in Patients with Hepatic Encephalopathy: A Real-World Study in the South of Italy.Journal of clinical medicine · 2023Article
- Article
- Barriers to Lactulose Adherence in Patients with Cirrhosis and Hepatic Encephalopathy.Digestive diseases and sciences · 2023Article
- Article
- Comparison of diet, lactulose, and metronidazole combinations in the control of pre-surgical clinical signs in dogs with congenital extrahepatic portosystemic shunts.Journal of veterinary internal medicine · 2022Article
- Evidence-based approach to management of hepatic encephalopathy in adults.World journal of hepatology · 2022Review
- Letter to editor 'prognostic significance of hepatic encephalopathy in patients with cirrhosis treated with Rifaxamin'.World journal of gastroenterology · 2020Article
- Thrombospondin-1 Exacerbates Acute Liver Failure and Hepatic Encephalopathy Pathology in Mice by Activating Transforming Growth Factor β1.The American journal of pathology · 2020Article
Corrections and comments
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Authors and funding
3 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundRifaximin and lactulose are common effective agents for hepatic encephalopathy (HE). Whether a combination of rifaximin and lactulose improves the efficacy and mortality in patients with HE compared with lactulose alone needs to be analyzed.
methodsA systematic search was performed in electronic databases and other sources for possible studies focusing on combination therapy of rifaximin and lactulose for HE between January 2000 and February 2018. A meta-analysis was performed by the method recommended by the Cochrane Collaboration, and estimated effect size was presented as risk difference (RD), 95% CI, and the number needed to treat (NNT). Subgroup analysis, sensitivity analysis, and Trial Sequence Analysis were comprehensively performed to indicate the source of heterogeneity and risk of bias.
resultsFive randomized and five observational studies involving 2,276 patients were included. Combination therapy had a significant advantage in both clinical efficacy increase (RD 0.26, 95% CI 0.19-0.32, NNT 5) and mortality decrease (RD -0.16, 95% CI -0.20-0.11, NNT 9) in overall analysis. In the pooled analysis of randomized studies, combination therapy showed similar results in clinical efficacy (RD 0.25, 95% CI 0.16-0.35, NNT 4) and mortality (RD -0.22, 95% CI -0.33-0.12, NNT 5). Compared with lactulose, hospital stay was also reduced in combination therapy, and there was no significant difference in treatment-related adverse events between the two groups.
conclusionCombination of rifaximin and lactulose has beneficial effects on HE. Compared with lactulose alone, additional rifaximin increases clinical efficacy and decreases mortality. However, its effects on different types of HE are still uncertain.
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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.