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Randomised controlled trial of lactulose versus rifaximin for prophylaxis of hepatic encephalopathy in patients with acute variceal bleed
  1. Sudhir Maharshi,
  2. Barjesh Chander Sharma,
  3. Siddharth Srivastava,
  4. Amit Jindal
  1. Department of Gastroenterology, G.B. Pant Hospital, New Delhi, India
  1. Correspondence to Dr Barjesh Chander Sharma, Department of Gastroenterology, Room No. 203, Academic Block, G.B. Pant Hospital, New Delhi 110002, India; drbcsharma{at}hotmail.com

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We read with interest the article by Peter Ferenci1 on the diagnosis of minimal hepatic encephalopathy (HE), still a challenge, and Goldbecker et al 2 on the comparison of the most favoured methods for the diagnosis of HE in liver transplantation candidates. Identification and treatment of the precipitating factors are the primary therapeutic option for HE. Variceal bleed seen in 25%–30% of patients with cirrhosis is an important precipitating factor for development of HE, and associated with increased morbidity and mortality.3 ,4 Acute variceal bleed (AVB) is an important precipitating factor for development of HE. There is a role of lactulose for prophylaxis of HE after AVB;5 however, there are no data on the role of rifaximin for prophylaxis of HE after AVB. We performed this study to compare the efficacy of lactulose versus rifaximin for prophylaxis of HE after AVB in …

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