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?
Should Rifaximin be added long-term to prevent future episodes, or is lactulose alone enough if taken regularly?

Kindly suggest.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

Your father’s episode is consistent with hepatic encephalopathy, a complication of liver cirrhosis, where toxins such as ammonia affect brain function. The main treatment is Lactulose, which works by trapping ammonia in the intestine and removing it through bowel movements.

The usual goal of Lactulose therapy is about two to three soft bowel movements per day. If he is passing four to five stools daily, this may still be acceptable if they are not watery and he is not dehydrated.

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. Recovery from encephalopathy can take several days, and doctors also look for triggers such as infection, constipation, dehydration, bleeding, or medication changes.

To reduce future episodes, doctors often add Rifaximin, especially if someone has already had an episode of overt encephalopathy. Rifaximin works by reducing ammonia-producing bacteria in the gut and is commonly used together with lactulose for prevention.

Long-term management includes strict adherence to Lactulose, avoiding alcohol, maintaining adequate nutrition, preventing constipation, and monitoring for infections.

Your father should continue regular follow-up with his liver specialist, as proper adjustment of medications and prevention strategies can significantly reduce recurrence and improve mental clarity.

I hope this helps.

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

Thank you.