Background Hepatic encephalopathy (HE) is defined as brain dysfunction that occurs because of acute liver failure or liver cirrhosis and is associated with significant morbidity and mortality. Lactulose is the standard of care till this date; however, polyethylene glycol (PEG) has gained the attention of multiple investigators.
Methods We screened five databases namely PubMed, Scopus, Web of Science, Cochrane Library and Embase from inception to 10 February 2021. Dichotomous and continuous data were analysed using the Mantel-Haenszel and inverse variance methods, respectively, which yielded a meta-analysis comparing PEG versus lactulose in the treatment of HE.
Results Four trials with 229 patients were included. Compared with lactulose, the pooled effect size demonstrated a significantly lower average HE Scoring Algorithm (HESA) Score at 24 hours (Mean difference (MD)=−0.68, 95% CI (−1.05 to –0.31), p<0.001), a higher proportion of patients with reduction of HESA Score by ≥1 grade at 24 hours (risk ratio (RR)=1.40, 95% CI (1.17 to 1.67), p<0.001), a higher proportion of patients with a HESA Score of grade 0 at 24 hours (RR=4.33, 95% CI (2.27 to 8.28), p<0.0010) and a shorter time to resolution of HE group (MD=−1.45, 95% CI (−1.72 to –1.18), p<0.001) in favour of patients treated with PEG.
Conclusion PEG leads to a higher drop in the HESA Score and thus leads to a faster resolution of HE compared with lactulose.
- hepatic encephalopathy
Data availability statement
All data relevant to the study are included in the article or uploaded as supplementary information.
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Contributors GJH: study conception and design, acquisition of data, statistical analysis, interpretation of data, drafting of the manuscript, critical revision of the manuscript for important intellectual content and submission of the manuscript. MFA: drafting of the manuscript and critical revision of the manuscript for important intellectual content. JNH: data analysis, interpretation of data, drafting of the manuscript and critical revision of the manuscript for important intellectual content. AA-Z: acquisition of data, interpretation of data, statistical analysis, drafting of the manuscript and critical revision of the manuscript for important intellectual content. CD and SD: acquisition of data and drafting of the manuscript. TA: critical revision of the manuscript for important intellectual content. SJ: critical revision of the manuscript for important intellectual content, statistical analysis and study supervision and is also responsible for the overall work as a guarantor.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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