AN INTERVENTIONAL STUDY ON THE EFFICACY OF RIFAXIMIN-LACTULOSE COMBINATION WITH AND WITHOUT PROBIOTICS IN THE TREATMENT OF HEPATIC ENCEPHALOPATHY IN SOUTH KERALA

Background: Hepatic Encephalopathy (HE) is a condition that is generally seen in individuals suffering from liver cirrhosis.  HE is described as a range of neuropsychiatric diseases in individuals with liver diseases. It is characterized by personality changes, intellectual impairment and a depressed consciousness. Toxic substances that are generally excluded from the body by the liver accumulate in the blood and ultimately reach the brain, causing HE. Incidence rate of HE is estimated by various authors at about 30-84% of cases with liver cirrhosis depending on the applied diagnostic methods and examined population. Ammonia is one of the major neurotoxins produced in HE. Various triggers of HE includes renal failure, GI bleeding, constipation, infection, alcohol consumption, etc. Typically, bacteria within the gastrointestinal tract generate ammonia, which is then processed and eliminated by the liver through metabolism. But in HE there is either a drop in the number of the performing hepatocytes, portosystemic shunting or both, resulting in dropped ammonia clearance and hyperammonaemia. Once ammonia crosses BBB, it has multiple neurotoxic effects, and which ultimately results in symptoms of HE. Earlier approaches towards the treatment of HE included antibiotics, lactulose, zinc supplementation etc. In today’s scenario probiotics have also been added to this regimen, contributing to reduction in ammonia levels. Hence improving the symptoms of HE.