Incidence of Hepatic Encephalopathy in Patients with Spontaneous Bacterial Peritonitis Using Rifaximin and Lactulose: A Study at a Tertiary Care Hospital in Rawalpindi

Objective: To determine the incidence of hepatic encephalopathy (HE) in cirrhosis patients with spontaneousbacterial peritonitis receiving Lactulose, Rifaximin, or a combination of both, and to compare the efficacy ofthese treatments.Study Design: Cross-sectional study.Place and Duration of Study: The study was conducted at the Department of Medicine, Pak Emirates MilitaryHospital Rawalpindi, Pakistan, from September 2021 to August 2022.Methods: Using consecutive sampling, diagnosed cases of decompensated Chronic Liver Disease with clinicallyapparent ascites, visiting the outpatient department, with or without signs and symptoms of spontaneousbacterial peritonitis (SBP) were included in the study after laboratory confirmation of spontaneous bacterialperitonitis. The drug history was taken, and hepatic encephalopathy was diagnosed using Mini-mental ScaleExamination and West-Haven criteria. The incidence of hepatic encephalopathy was compared across thegroups using the Pearson Chi-square test.Results: A total of 60 diagnosed Chronic liver disease patients with spontaneous bacterial peritonitis wereincluded in the study. Rifaximin was being used by 41.7% (n=25), 41.7% (n=25) patients were using lactulosealone and 16.7% (n=10) were using a combination of both drugs. 58.3% (n=35) of patients were found to havehepatic encephalopathy. Out of these, 42.8% (n=15) were using rifaximin alone, 54.2% (n=19) were usinglactulose alone, while just 2% (n=1) patients were using the combination of both drugs (P < 0.001).Conclusion: Spontaneous Bacterial Peritonitis is an important trigger of hepatic encephalopathy in the settingof decompensated chronic liver disease and is associated with high mortality. The use of lactulose and rifaximincombination is superior to monotherapy with either of them for preventing hepatic encephalopathy in thesepatients.