Nitazoxanide Plus Lactulose Versus Lactulose Alone Treatment of Hepatic Encephalopathy
关键词
抽象
描述
Hepatic encephalopathy (HE) is a reversible neuropsychiatric syndrome associated with chronic and acute liver dysfunction. It is characterized by cognitive and motor deficits of varying severity.
Hepatic encephalopathy is caused by accumulation of nitrogenous substances, primarily ammonia, in the blood. In advanced stages it is referred to as hepatic coma which may be preceded by seizures. The treatment goal is to reduce nitrogen load from the GI tract and to improve central nervous system (CNS) status.
Treatment options include lactulose administered orally or by nasogastric tube or enema, non-absorbable antibiotics, and protein-restricted diets.
Lactulose is nonabsorbable disaccharides that are currently used as first line agents for the treatment of HE. Its action is thought to beconversion to lactic acid and acetic acid resulting in acidification of the gut lumen. This favors conversion of ammonia (NH3) to ammonium (NH4+), which is relatively membrane impermeable, and inhibits ammoniagenic coliform bacteria.
Nitazoxanide is an oral agent indicated for the treatment of infectious diarrhea caused by Crytpsporidiumparvum and Giardia lamblia. Basu and colleagues presented a pilot prospective study at the 2008 American Association for the Study of Liver Diseases meeting showing clinical improvement in HE among cirrhotic patients who received nitazoxanide and lactulose.
Mantry and colleagues showed that the number of hospitalizations and the duration of hospital stays were shortened for patients receiving combination therapy compared with those receiving lactulose monotherapy.
日期
最后验证: | 07/31/2017 |
首次提交: | 06/02/2015 |
提交的预估入学人数: | 06/02/2015 |
首次发布: | 06/07/2015 |
上次提交的更新: | 08/15/2017 |
最近更新发布: | 08/20/2017 |
实际学习开始日期: | 12/31/2015 |
预计主要完成日期: | 11/30/2017 |
预计完成日期: | 11/30/2017 |
状况或疾病
干预/治疗
Drug: lactulose plus nitazoxanide
Drug: Lactulose
相
手臂组
臂 | 干预/治疗 |
---|---|
Experimental: lactulose plus nitazoxanide Nitazoxanide dosing: 500 mg tablets twice daily
Lactulose dosing: 30-60 mL PO TID with goal 2-3 semisoft stools per day | Drug: lactulose plus nitazoxanide • Nitazoxanide dosing: 500 mg tablets twice daily |
Active Comparator: Lactulose alone Lactulose dosing: 30-60 mL PO TID with goal 2-3 semisoft stools per day |
资格标准
有资格学习的年龄 | 18 Years 至 18 Years |
有资格学习的性别 | All |
接受健康志愿者 | 是 |
标准 | Inclusion Criteria: Age 18-70 years Cirrhosis, defined by a combination of any of the following: - Laboratory findings - Endoscopic results - Ultrasound - Histology Overt hepatic encephalopathy Exclusion Criteria: - • Creatinine>1.5 mg/dl - Alcohol use within prior 4 weeks - Non-hepatic metabolic encephalopathy - Hepatocellular carcinoma - Degenerative CNS disease - Any significant psychiatric illness or other medical comorbidity |
结果
主要结果指标
1. Number of patients with total reversal of hepatic encephalopathy [6 months]