Effectiveness and Clinical Effects of Long-Term Rifaximin in Cirrhotic Patients with Hepatic Encephalopathy

Abstract

Background: Rifaximin has emerged as a new primary treatment for the treatment and management of hepatic encephalopathy in cirrhosis patients. This study aimed to evaluate the efficacy of long-term rifaximin therapy and its clinical effects on hepatic encephalopathy in patients with liver cirrhosis.

Material and Methods: A retrospective cohort study was conducted in the Medicine Department of Nishtar Hospital, Multan from April 2022 to October 2023. A total of 100 liver cirrhosis patients were selected for the study by consecutive sampling. The patients were divided into two groups; the cohort group including 50 patients who were administered rifaximin for 6 months at our hospital and the control group including 50 patients who were not administered rifaximin. The primary end-point of our analysis was to assess the effectiveness of long-term rifaximin therapy and the secondary end-points were the effect of shunts and E.coli infection. The clinical outcomes between both groups were evaluated by measuring liver stiffness by magnetic resonance elastography using age, Child-Pugh score, incidence of hepatocellular carcinoma, and MRE as covariables.

Results: The baseline serum ammonia     was 105 (60-296) in rifaximin group which decreased to 83 (33-152) after 14 days and 83 (44-190) after 60 weeks (p=0.001). Overt HE recurred in 2 patients during pleural drainage and self-interruption of the drug. Albumin, platelet count, total bilirubin, and prothrombin time did not change significantly after treatment. Adverse effects of rifaximin were presented in one patient (2%) in the form of diarrhea only.  A total of 23 patients (46%) had shunts larger than 8mm with pretreatment ammonia of 110 (92-295) and 83 (52-148) after 6 months (p=0.001). The patients with shunts smaller than 8 mm had pretreatment ammonia of 100 (60-182) and 65 (42-145) post-treatment (P=0.040). 39 patients (78%) patients had two or more shunts with pretreatment ammonia of 102 (70-295) and 81.2 (42-149) after treatment (p<0.001).

Conclusion: Rifaximin is an effective and safe treatment regimen for the long-term treatment of hepatic encephalopathy in patients with liver cirrhosis. It reduces the serum ammonia levels and prevents E.coli infections, increasing survival. Ineffective rifaximin treatment was associated with portosystemic shunt diameter ≥ 8.

Keywords: Ammonia, Cirrhosis, Hepatic encephalopathy, Rifaximin