Pharmacological prophylaxis of hepatic encephalopathy after transjugular intrahepatic portosystemic shunt: a randomized controlled study

Background/Aims: Hepatic encephalopathy is a frequent event after transjugular-intrahepatic-portosystemic-shunt (TIPS), especially during the first months. Aim of this study was to compare two different treatments (lactitol 60 g/day, rifaximin 1200 mg/day) with no-treatment in the prevention of post-TIPS hepatic encephalopathy. Methods: Seventy-five consecutive cirrhotics submitted to TIPS were randomized to receive either one of the above treatments or no-treatment. The main end-point was the occurrence of an episode of overt hepatic encephalopathy during the first month post-TIPS. Before the procedure and weekly thereafter the patients were evaluated by examining their mental status, asterixis, ammonia and trail-making-test Part-A (TMT-A). Results: The three groups were comparable for age, sex, etiology, Child-Pugh-score, post-TIPS porto-systemic gradient, previous hepatic encephalopathy, basal values of ammonia and psychometric performance. Twenty-five patients developed hepatic encephalopathy (33 %, CI 95 % = 22-45 %). One-month incidence was similar in the three groups (P=0.97). Previous hepatic encephalopathy (Relative Hazard= 3.79;1.27-11.31) and basal-TMT-A Z-score > 1.5 (RH = 3.55; 1.24-10.2) were predictors of post-TIPS encephalopathy at multivariate analysis. A < 5 mmHg porto systemic gradient was also significantly related to the occurrence of encephalopathy. Conclusions: Our data show that treatment with lactitol or rifaximin is not effective in the prophylaxis of hepatic encephalopathy during the first month after a TIPS. (c) 2005 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.