Secondary Prophylaxis of Hepatic encephalopathy in Liver cirrhosis: Rifixamine plus Probiotics vs. Rifixamine alone

Abstract

Objective: To determine the efficacy of adding probiotics with rifaximin for the secondary prevention of hepatic encephalopathy in patients with liver cirrhosis.

Methodology: In this qausi experimental study, conducted in Department of Medicine, Jinnah Hospital Lahore from December 2024 to May 2025, 120 patients with liver cirrhosis and history of at least one episode of hepatic encephalopathy were enrolled. Participants were allocated into two groups: Group-A received rifaximin 550 mg twice daily along with Saccharomyces boulardii-based probiotics twice daily, while Group-B was treated with rifaximin alone. All patients were followed up for six months to monitor for recurrence of hepatic encephalopathy. Data analysis was conducted using SPSS 25 and p-value of less than 0.05 was considered statistically significant.

Results: Among 120 included patients with a mean age of 55.71years (±10.18) and a male-to-female ratio of 1.2 (66/54), hepatic encephalopathy recurred in nine patients (15%) in Group-A compared to 23 patients (38.3%) in Group-B, (p=0.004). The baseline characteristics, including liver disease severity and comorbidities, were comparable between the groups. Among patients who experienced recurrence of hepatic encephalopathy there were no significant differences in age, duration of liver disease, INR, serum creatinine, albumin levels, or presence of ascites, highlighting the treatment regimen as the primary factor influencing outcomes.

Conclusion: The addition of probiotics to rifaximin therapy markedly decreased the recurrence of hepatic encephalopathy compared to rifaximin alone, suggesting a more effective strategy for secondary prevention.