{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T04:20:36Z","timestamp":1792210836997,"version":"4.4.0"},"reference-count":31,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2015,8,17]],"date-time":"2015-08-17T00:00:00Z","timestamp":1439769600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"Dayanand Medical College and Hospital"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Liver International"],"published-print":{"date-parts":[[2016,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background &amp; Aims<\/jats:title>\n                    <jats:p>\n                      Lactulose and rifaximin have already been shown to improve both cognitive functions and health related quality of life (\n                      <jats:styled-content style=\"fixed-case\">HRQOL<\/jats:styled-content>\n                      ) in\n                      <jats:styled-content style=\"fixed-case\">MHE<\/jats:styled-content>\n                      patients. We aimed to compare the efficacy of rifaximin with lactulose in reversal of\n                      <jats:styled-content style=\"fixed-case\">MHE<\/jats:styled-content>\n                      and improvement in\n                      <jats:styled-content style=\"fixed-case\">HRQOL<\/jats:styled-content>\n                      in cirrhotic patients with\n                      <jats:styled-content style=\"fixed-case\">MHE<\/jats:styled-content>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>\n                      This prospective, randomized, open label, non\u2010inferiority trial, was conducted at the Gastroenterology department of a tertiary care institute in Northern India.\n                      <jats:styled-content style=\"fixed-case\">MHE<\/jats:styled-content>\n                      was diagnosed if any two of the five neuro\u2010psychometric (\n                      <jats:styled-content style=\"fixed-case\">NP<\/jats:styled-content>\n                      ) tests were positive.\n                      <jats:styled-content style=\"fixed-case\">HRQOL<\/jats:styled-content>\n                      was assessed using the sickness impact profile (\n                      <jats:styled-content style=\"fixed-case\">SIP<\/jats:styled-content>\n                      ) questionnaire (John Hopkins University,\n                      <jats:styled-content style=\"fixed-case\">USA<\/jats:styled-content>\n                      ).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of 527 cirrhotics screened, 351 were found eligible and tested for\n                      <jats:styled-content style=\"fixed-case\">MHE<\/jats:styled-content>\n                      . A total of 112 (31.9%) patients were found to have\n                      <jats:styled-content style=\"fixed-case\">MHE<\/jats:styled-content>\n                      and then randomized into two groups group A (lactulose; 30\u2013120\u00a0ml\/day) and B (Tablet. rifaximin; 400\u00a0mg thrice a day). Based on the intention\u2010to\u2010treat population, the proportion of patients with\n                      <jats:styled-content style=\"fixed-case\">MHE<\/jats:styled-content>\n                      reversal at 3\u00a0months was 73.7% (42\/57) in the rifaximin arm and 69.1% (38\/55) in the lactulose arm [4.6% difference (90% CI \u22129.3% to 18.4%)]. However, non\u2010inferiority of rifaximin over lactulose could not be established as the pre\u2010specified non\u2010inferiority margin (\u22125%) lies within the two\u2010sided 90% confidence interval of the difference.\n                      <jats:styled-content style=\"fixed-case\">HRQOL<\/jats:styled-content>\n                      was significantly improved in both groups (\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0=\u00a00.20). However, the proportion of patients with flatulence (\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0=\u00a00.004) and diarrhoea (\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0=\u00a00.0002) was significantly higher in patients who took lactulose.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      Non\u2010inferiority of rifaximin over lactulose for\n                      <jats:styled-content style=\"fixed-case\">MHE<\/jats:styled-content>\n                      reversal was not established.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/liv.12921","type":"journal-article","created":{"date-parts":[[2015,7,22]],"date-time":"2015-07-22T11:12:36Z","timestamp":1437563556000},"page":"378-385","source":"Crossref","is-referenced-by-count":59,"title":["Rifaximin vs. lactulose in treatment of minimal hepatic encephalopathy"],"prefix":"10.1111","volume":"36","author":[{"given":"Sandeep S.","family":"Sidhu","sequence":"first","affiliation":[{"name":"Department of Gastroenterology Dayanand Medical College and Hospital Ludhiana Punjab India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Omesh","family":"Goyal","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Dayanand Medical College and Hospital Ludhiana Punjab India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard A.","family":"Parker","sequence":"additional","affiliation":[{"name":"Edinburgh Health Services Research Unit University of Edinburgh Edinburgh UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harsh","family":"Kishore","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Dayanand Medical College and Hospital Ludhiana Punjab India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ajit","family":"Sood","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Dayanand Medical College and Hospital Ludhiana Punjab India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2015,8,17]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1053\/jhep.2002.31250"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cld.2011.12.002"},{"key":"e_1_2_8_4_1","first-page":"180","article-title":"The diagnosis and treatment of minimal hepatic encephalopathy","volume":"109","author":"Zhan T","year":"2012","journal-title":"Dtsch Arztebl Int"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1572-0241.2001.04130.x"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1034\/j.1600-0676.2002.01431.x"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.510290619"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1136\/gut.2007.122176"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11011-006-9042-1"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/MEG.0b013e3282f3e6f5"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0016-5085(85)80004-4"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2010.455"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2036.2010.04574.x"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1097\/MEG.0b013e32834696f5"},{"key":"e_1_2_8_15_1","first-page":"703","article-title":"Multistrain probiotic and lactulose in the treatment of minimal hepatic encephalopathy","volume":"19","author":"Shavkhi A","year":"2014","journal-title":"J Res Med Sci"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2010.08.061"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0060042"},{"key":"e_1_2_8_18_1","first-page":"2","volume-title":"Manual of Indian Adaptation of WAIS Performance Scale","author":"Ramalingaswamy P","year":"1974"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1440-1746.1995.tb01041.x"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1097\/00005650-198108000-00001"},{"key":"e_1_2_8_21_1","unstructured":"International Conference on Harmonisation Tripartite Guideline E9: Statistical Principles for Clinical Trials. 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