Recurrence of Hepatic Encephalopathy after TIPS: Effective Prophylaxis with Combination of Lactulose and Rifaximin

Autor:	Martin Schoster, Jan Frederic Weller, Leon Louis Seifert, Hauke Heinzow, Max Masthoff, Miriam Maschmeier, Moritz Wildgruber, Michael Köhler, Hartmut Schmidt, Philipp Schindler, Christian Wilms
Jazyk:	angličtina
Rok vydání:	2021
Předmět:	medicine.medical_specialty medicine.medical_treatment hepatic encephalopathy Medizin Tertiary care Gastroenterology Article chemistry.chemical_compound Lactulose Internal medicine transjugular intrahepatic portosystemic shunt medicine In patient complications of liver cirrhosis Hepatic encephalopathy business.industry portal hypertension General Medicine medicine.disease Rifaximin chemistry Medicine Portal hypertension Complication business Transjugular intrahepatic portosystemic shunt medicine.drug decompensated liver cirrhosis
Zdroj:	Journal of Clinical Medicine Journal of Clinical Medicine, Vol 10, Iss 4763, p 4763 (2021) Volume 10 Issue 20
ISSN:	2077-0383
Popis:	Background: Transjugular intrahepatic portosystemic shunt (TIPS) implantation is an established procedure to treat portal hypertension with hepatic encephalopathy (HE) as a common complication. There is lack of evidence concerning HE prophylaxis after TIPS. Methods: N = 233 patients receiving TIPS between 2011 and 2018 at a German tertiary care center were included. Of them, 21% (n = 49) had a history of HE. The follow-up period was 12 months. The risk factors of post-TIPS HE were analyzed via multivariate analysis. The efficacy of prophylactic medication regimens was studied. The results show that 35.6% (n = 83) received no medication (NM), 36.5% (n = 85) received lactulose monoprophylaxis (LM), 2.6% (n = 6) rifaximin monoprophylaxis (RM) and 25.3% (n = 59) lactulose and rifaximin (LR) of which 64.4% received l-ornithin-l-aspartate (LOLA) additionally (LR + LOLA) and 36.6% did not (LRonly). Results: Multivariate analysis revealed higher age (p = 0.003) and HE episodes prior to TIPS (p = 0.004) as risk factors for HE after TIPS. LM has no prophylactic effect. LR prevents HE recurrence at 1, 3 and 12 months after TIPS (p = 0.003, p = 0.003, p = 0.006) but does not prevent HE in patients with no history of HE (p = 0.234, p = 0.483, p = 0.121). LR prevents HE recurrence compared with LM/NM (25.0% vs. 64.7%, p = 0.007) within 12 months after TIPS, whereas de novo occurrence is unaffected (p = 0.098). The additional administration of LOLA to LR has no benefit (LRonly: 25.0%, LR + LOLA: 29.7%, p = 0.780). Conclusions: Higher age and previous HE are risk factors post-TIPS HE. In patients with HE prior to TIPS, effective prophylaxis of HE is feasible via combination of lactulose and rifaximin with no additional benefit from LOLA.
Databáze:	OpenAIRE
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