Rifaximin in the treatment of hepatic encephalopathy

By M. Iadevaia, A. Prete, Claudia Cesaro, L. Gaeta, C. Zulli, C. Loguercio. Hepatic Medicine : Evidence and Research, 2011

675 citations recorded by the source corpus.

Hepatic encephalopathy is a challenging complication in patients with advanced liver disease. It can be defined as a neuropsychiatric syndrome caused by portosystemic venous shunting, ranging from minimal to overt hepatic encephalopathy or coma. Its pathophysiology is still unclear, although increased levels of ammonia play a key role. Diagnosis of hepatic encephalopathy is currently based on specific tests evaluating the neuropsychiatric state of patients and their quality of life; the severity of hepatic encephalopathy is measured by the West Haven criteria. Treatment of hepatic encephalopathy consists of pharmacological and corrective measures, as well as nutritional interventions. Rifaximin received approval for the treatment of hepatic encephalopathy in 2010 because of its few side effects and pharmacological benefits. The aim of this work is to review the use and efficacy of rifaximin both in acute and long-term management of hepatic encephalopathy. Treatment of overt hepatic encephalopathy involves management of the acute episode as well as maintenance of remission in those patients who have previously experienced an episode, in order to improve their quality of life. The positive effect of rifaximin in reducing health care costs is also discussed.

Subfields: Epidemiology, Hepatology, Surgery

View Paper: https://www.semanticscholar.org/paper/8aaa4a19b8ca8e0b25a2d2ffb670260320cb70fe

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Citations in the corpus

Hepatic encephalopathy in chronic liver disease: 2014 practice guideline by the European Association for the Study of the Liver and the American Association for the Study of Liver Diseases. (2014, background): “A multinational study [101] with patients having two earlier OHE bouts to maintain remission showed the superiority of rifaximin”
Promotion of Hepatocellular Carcinoma by the Intestinal Microbiota and TLR4 (2012, background): “We additionally tested whether more selective gut decontamination with rifaximin, a widely used non-absorbable antibiotic for the prevention of hepatic encephalopathy in patients with end-stage liver disease (Bass et al., 2010), could influence hepatocarcinogenesis at late stages.”
Bacterial infections in cirrhosis: a position statement based on the EASL Special Conference 2013. (2014, background): “Its administration in patients with hepatic encephalopathy is not associated with the development of infections by MR bacteria [157].”
Hepatic encephalopathy in chronic liver disease: 2014 Practice Guideline by the American Association for the Study Of Liver Diseases and the European Association for the Study of the Liver (2014, background): “Rifaximin added to lactulose is the best-documented agent to maintain remission in patients who have already experienced one or more bouts of OHE while on lactulose treatment after their initial episode of OHE.(101) Hepatic Encephalopathy After TIPS.”
Modulation of the Fecal Bile Acid Profile by Gut Microbiota in Cirrhosis (2013, positive): “Therefore, to further study this mechanism, we conducted pre–post analysis after rifaximin, a broad-spectrum antibiotic that has shown to be efficacious in hepatic encephalopathy and travelers’ diarrhea and has activity against Clostridia, especially Clostridium difficile [18,19].”
Acute-on chronic liver failure. (2012, background): “Conversely, reduction in bacterial translocation using a nonabsorbable antibiotic, rifaximin was shown to prevent the occurrence of HE, suggesting that reducing inflammation may be protective as well [114].”