Nonabsorbable Disaccharides And Antibiotics For Hepatic Encephalopathy

Background: Experimental data indicates that Nonabsorbable disaccharides and antibiotics can interfere with the process of hepatic encephalopathy in multiple aspects. Many trials have been published and those have been assessed.Objective: he aim of systematic review is to assess the effectiveness and safety of nonabsorbable disaccharides and antibiotics in the treatment of hepatic encephalopathy.Methods: A Cochrane systematic review of randomized controlled trials of nonabsorbable disaccharides and antibiotics for hepatic encephalopathy was performed. Trials were identified by searching for Cochrane Controlled Trials Register (CENTRAL/CCTR) 2004 Issue 1, Medline( 1980-2004,2), Embase( 1980-2004,2) and the Chinese Biological Medicine Database (CBM-disc). We handsearched the data from the proceedings of correlated conferences and the references of all included trials. Two reviewers assessed quality of studies, extracted data independently. Disagreement were resolved by discussion or the third party if needed. The following primary outcomes were assessed: 1) Clinical effective rate. 2)Adverse events. 3)Death at the end of treatment. Secondary outcome measures were: 1) Blood ammonia concentration. 2) Total days of treatment. 3) Mental state. 4)Asterixis. 5)The number connection test. 6) Digit symbol test. 7) Electroencephalography. 8)Mean stool pH.Results: Nineteen trials involving 979 patients were included. Most trials were of poor quality. There was significant difference in the clinical effective rate, Blood ammonia concentration,the number connection test and Digit symbol test at the end of the treatment between nonabsorbable disaccharides and normal control group(p<0.05 ). And there wasn't a significant difference betweent nonabsorbable disaccharides and antibiotics in the clinical effective rate for hepatic encephalopathy (Peto OR 1.17? 95%CI 0.74 to 1.86, P = 0.5 ) . The reported adverse events of nonabsorbable antibiotics was lesser than those of nonabsorbable disaccharides (Peto OR 0.30, 95% CI 0.18 to 0.50, P<0.00001). There was significant difference in the treatment between nonabsorbable antibiotics and nonabsorbable disaccharides (SMD ^j-0.32, 95% CI -0.54 to-0.09, P=0.005) orplaceboCSMD ^-0.71, 95% CI ^J-1.22 to-0.21, p=0.006) .Conclusions: Nonabsorbable disaccharides and antibiotics appear to be modality of safe and effective treatment with a favourable trend, but there is not enough evidence to support this conclusion at present as trails published is not good quality. More trials with enough sample size and scientifically sound methodology are required.