Authors' response to "How to dispel myths in the treatment of hepatic encephalopathy?"

Arising from: Braillon A (2007) Nat Clin Pract Gastroenterol Hepatol 4: E1

In our Review, we emphasized the lack of evidence-based support for the treatment of portosystemic encephalopathy. In the study by Als-Nielsen,¹ an improvement was observed with the use of non-absorbable disaccharides compared with placebo or no intervention in an analysis of six studies (relative risk 0.62, 95% confidence interval 0.46–0.84). Of these studies, there was no discernable difference noted in two studies deemed to have satisfactory blinding or allocation concealment. Published studies including those with a vigorous design have been limited by the difficulties in determining the impact of removing precipitating factors, such as infection or gastrointestinal hemorrhage, spontaneous improvement or appropriate dose titration. Given the absence of evidence of an adverse effect, it should be left up to the individual clinician to consider the value of this unproven but potentially beneficial therapy relative to the workload of a nurse's aide.