Comparison of polyethylene glycol 3350 electrolyte solution and lactulose in patients with overt hepatic encephalopathy: A retrospective study from a tertiary care hospital

Abstract

Background: Hepatic encephalopathy (HE) is a brain dysfunction caused by liver failure and/or porto-systemic shunt and it manifests as a wide spectrum of neurological or psychiatric abnormalities. The aim of the study was to evaluate if polyethylene glycol (PEG) is more effective than lactulose in resolution of encephalopathy and determine if it decreases the hospital stay. Material and methods: Retrospectively from hospital records we selected 80 patients with hepatic encephalopathy (HE) due to underlying cirrhosis of liver. Forty (40) patients were taken from the group who were treated with lactulose and based on age matching (± 2 years) and encephalopathy grade matching (±1 grade) 40 patients were selected from the group who were treated with PEG. Grading of HE was determined by using hepatic encephalopathy scoring algorithm (HESA) and West Haven (WH) criteria. Resolution of HE was defined as improvement in HESA/West Haven score to grade 0, patient discharge or 2 consecutive days when HESA grade remained at 1 after an initial improvement of at least 1 full grade. Results: The mean age of PEG group was similar to lactulose group (58.2 ± 10.11 vs 58.70 ± 9.54 years; p = 0.829) with a male predominance in both groups. All patients were of Child Turcot Pugh (CTP) class C with a mean MELD score of 18.7±5.42 vs 18.9±4.75 in PEG group and lactulose group respectively (p = 0.827). The time taken for complete resolution of HE was also lesser in PEG group compared to lactulose group with a significant p value of <0.001. Conclusions: PEG therapy significantly improved the overall grade of encephalopathy in first 24 hours and reduced days to complete resolution of hepatic encephalopathy.

Keywords

• hepatic encephalopathy
• cirrhosis
• lactulose
• polyethylene glycol