A systematic review and meta-analysis found that polyethylene glycol (PEG) leads to a more rapid resolution of hepatic encephalopathy (HE) than lactulose. These findings were published in the Journal of Clinical Gastroenterology.

Researchers from The Second Affiliated Hospital of Guangxi Medical University and Liuzhou Traditional Chinese Medical Hospital in China searched publication databases through December 2020 for studies on PEG and lactulose for the treatment of HE. A total of 7 randomized trials were included in this analysis.

The study population included 432 patients (63% men, aged 40-60 years) who had minimal, chronic, or acute HE and cirrhosis. Daily doses of PEG ranged from 2 to 4 L, with 118 g PEG/L (n=215); patients receiving lactulose were given 30 to 60 mL 3 times daily (n=217).


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Among 5 of the studies, PEG more significantly increased the HE Scoring Algorithm (HESA) within 24 hours (relative risk [RR], 1.46; 95% CI, 1.26-1.68; P =.000). This comparison did not include publication bias (P =.077) or heterogeneity (I2, 0%; P =.444).

The length of stay in 6 studies was observed to be significantly reduced among the PEG recipients (weighted mean difference [WMD], -1.78; 95% CI, -2.72 to -0.85; P =.000). This comparison had no evidence of publication bias (P =.914) but did have evidence of heterogeneity (I2, 90.1%; P <.05).

Adverse events among all studies did not differ significantly between treatment arms (RR, 0.75; 95% CI, 0.48-1.19; P =.222). No evidence of publication bias (P =.345) or heterogeneity (I2, 7.2%; P =.357) was observed.

No significant difference in the level of serum ammonia was observed (WMD, 9.02; 95% CI, -14.39 to 32.43; P =.45). This comparison had significant heterogeneity (I2, 84.9%; P =.001).

This analysis was based on few studies with poor quality.

The study authors concluded that these data indicated PEG was more effective at treating HE compared with lactulose; PEG treatment was also associated with decreased length of stay without increasing adverse events of serum ammonia levels.

Reference

Li M, Zhang Z, Chen Q, Zhou X, Shui D, Huang J. Comparative effectiveness and safety of polyethylene glycol electrolyte solution versus lactulose for treatment of hepatic encephalopathy: a systematic review and meta-analysis. J Clin Gastroenterol. 2022;56(1):41-48. doi:10.1097/MCG.0000000000001621