Published online Jun 27, 2019. doi: 10.4254/wjh.v11.i6.531
Peer-review started: May 10, 2019
First decision: June 3, 2019
Revised: June 9, 2019
Accepted: June 17, 2019
Article in press: June 17, 2019
Published online: June 27, 2019
Hepatic encephalopathy (HE) is a complication of liver cirrhosis. Rifaximin, an antibiotic, has been reported to decrease the occurrence of overt HE and improve cognitive function in studies from Europe and the United States of America. There is not enough evidence of the relationship between the long-term use of rifaximin and its clinical effects in the Japanese.
To determine the clinical effects of long-term rifaximin therapy in decompensated liver cirrhosis patients, with overt HE or hyperammonemia. We evaluated the relationship between the long-term use of rifaximin and its clinical effects and the size of the shunts.
In this single-center retrospective observational cohort study, we reviewed the data of 38 patients who had taken rifaximin at the dose of 1200 mg/d for more than 24 wk. The primary outcome measured was the efficacy of long-term rifaximin use, and the secondary outcome measured was the safety of its long-term use as determined by its influence on portosystemic shunts.
Rifaximin did not worsen the functionality of the liver 24 wk after the treatment. Adverse events included 2 cases of diarrhea (5.3%), which improved following the intake of probiotics. There were no cases of treatment interruption due to adverse events. Serum ammonia levels were significantly decreased 2 wk after the beginning of rifaximin compared to the pretreatment levels (P = 0.002), and it remained significantly lower for up to 60 wk. Multivariate analyses revealed that the insufficient improvement in the serum ammonia level was independently associated with the maximum shunt diameter of ≥ 8.0 mm (risk ratio = 5.52, P = 0.040).
The long-term use of rifaximin was found to be safe and effective in the Japanese population.
In this retrospective study, we did not examine each test to diagnose minimal HE, and the improvement of minimal HE cannot be proved. Tests as the Trail Making Test should be evaluated to minimal HE in the future investigation.