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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

https://doi.org/10.1136/gutjnl-2014-308521

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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 al2 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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    Footnotes

    • Contributors SM and AJ: Patient enrolment, study investigations, data recording and analysis, interpretation of data, drafting of manuscript. BCS and SS: Study conception and design, study supervision, critical revision for important intellectual content, final approval of the version to be published. BCS: Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of article are appropriately investigated and resolved.

    • Competing interests None.

    • Patient consent Obtained.

    • Ethics approval Institutional Ethics Committee, Maulana Azad Medical College and associated Hospitals, New Delhi, India.

    • Provenance and peer review Not commissioned; internally peer reviewed.