My father has overt hepatic encephalopathy. Can Rifaximin help?

Question

Hello doctor,

I am writing about my father, age 58, who has cirrhosis due to alcohol and was recently admitted for confusion and drowsiness. Doctors said it was overt hepatic encephalopathy and started Lactulose syrup. Our concerns are:

He is passing stools four to five times daily now. Is this the correct number, or is it too much?
Sometimes he still seems slow and forgetful even after stools. Does this mean treatment is not working fully?
Would Rifaximin need to be considered for long-term use to prevent recurrence, or does just Lactulose work adequately if taken on a routine basis?

Kindly suggest.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

The condition seen in your father appears to be hepatic encephalopathy due to his underlying liver cirrhosis, wherein toxins like ammonia interfere with normal brain functions. The primary treatment option for such patients is Lactulose, which basically sequesters ammonia within the intestine and eliminates it via defecation.

The common target for Lactulose is two to three bowel movements per day. Passing four to five stools per day may be okay, provided they are not loose and that there is no dehydration.

However, very frequent diarrhea can cause electrolyte imbalance and weakness, so the dose may need adjustment by his doctor.

It is also common for patients to remain a little slow or forgetful for some time, even after bowel movements improve. The recovery period from encephalopathy takes several days, and also physicians consider factors that might cause this condition, like infection, constipation, dehydration, hemorrhage, and change in medication.

In order to prevent future occurrences of this condition, physicians usually prescribe Rifaximin, especially if the patient has had an occurrence of overt encephalopathy. Rifaximin reduces the amount of ammonia-producing bacteria in the intestine and is prescribed along with Lactulose.

Management of encephalopathy includes strict use of Lactulose, no alcohol consumption, proper nutrition, no constipation, and prevention of any possible infections.

Your father needs to visit his hepatologist on a regular basis, as correct adjustment of medication can greatly help avoid this problem in the future and maintain mental clarity.

I hope this helps.

For more queries, feel free to reach out to me anytime.

Thank you.