• Qian Jiang, Xue-Hua Jiang, Ming-Hua Zheng, Liu-Ming Jiang, Yong-Ping Chen, and Li Wang.
• Department of Clinical Pharmacy, West China School of hepatic encephalopathy, Sichuan University, Chengdu, China.
• Eur J Gastroenterol Hepatol. 2008 Nov 1; 20 (11): 1064-70.

ObjectiveTo compare the positive and negative effects of rifaximin and nonabsorbable disaccharides in patients with hepatic encephalopathy.MethodsWe used the method recommended by The Cochrane Collaboration to perform a meta-analysis of comparative randomized trials of rifaximin and nonabsorbable disaccharides.ResultsSeven randomized controlled trials were identified, but only five trials involving 264 patients met all the inclusion criteria. There was no significant difference between rifaximin and nonabsorbable disaccharides on improvement in patients with hepatic encephalopathy [relative risk (RR) 1.08; 95% confidence interval (CI), 0.85-1.38; P=0.53]. RR was 0.98 (95% CI: 0.85-1.13; P=0.74) for acute hepatic encephalopathy in 157 patients and 0.87 (95% CI: 0.40-1.88; P=0.72) for chronic hepatic encephalopathy in 96 patients, respectively. There was no significant difference between rifaximin and nonabsorbable disaccharides on diarrhea (RR=0.90; 95% CI: 0.17-4.70; P=0.90). However, a significant difference in favor of rifaximin on abdominal pain (RR=0.28; 95% CI: 0.08-0.95; P=0.04) was identified.ConclusionRifaximin is not superior to nonabsorbable disaccharides for acute or chronic hepatic encephalopathy in the long-term or short-term treatment except that it may be better tolerated. Further studies on larger populations are required to provide more sufficient evidence for assessment of the use of rifaximin.

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