Alimentary pharmacology & therapeutics · 2026
Rifaximin Improves Cognitive Performance and Reduces Cirrhosis-Related Adverse Events in Covert Hepatic Encephalopathy: A Randomized Controlled Trial.
СтатьяРандомизированное исследованиеМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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Inada Hiroki, Toyota Toshinori, Uojima Haruki, Iio Etsuko, Miwa Takao, Miuma Satoshi, Miyase Shiho, Mizuta Takahiro, Maeda Daiki, Nagaoka Katsuya, Narahara Satoshi, Kurano Sotaro, Tanaka Kentaro, Yoshimaru Yoko, Watanabe Takehisa, Iwasaki Shuichiro, Hidaka Hisashi, Sugi Kazuhiro, Setoyama Hiroko, Shimizu Masahito, Nakayama Jiro, Tanaka Yasuhito
Аннотация
BACKGROUND: Covert hepatic encephalopathy (CHE) is associated with cognitive impairment and adverse clinical outcomes; however, randomized evidence supporting therapeutic intervention remains limited.
AIM: To evaluate the efficacy of rifaximin (RFX) as a treatment for CHE.
METHODS: In this multicentre, open-label randomized controlled trial, patients with CHE associated with liver cirrhosis were randomized (1:1) to receive RFX or no treatment and followed for 12 weeks. The primary endpoint was the change in Stroop test performance. Secondary endpoints included NCT-B scores, serum ammonia levels, cirrhosis-related adverse events, and gut microbiota composition.
RESULTS: Fifty patients were randomized and completed follow-up. Stroop test performance improved significantly in the RFX group (p = 0.006) but not in controls (p = 0.400), with a trend toward greater improvement with RFX (Δ Stroop test: -4.45 ± 7.12 vs. -0.98 ± 5.74 s; p = 0.056). Among patients not receiving synthetic disaccharides at baseline, improvement was significantly greater with RFX (Δ Stroop test: -3.73 ± 5.96 vs. -0.80 ± 5.86 s; p = 0.049). No significant changes were observed in NCT-B scores or serum ammonia levels. Cirrhosis-related adverse events were significantly reduced in the RFX group (p = 0.006). Overall, gut microbial diversity did not differ between groups; however, RFX selectively altered specific taxa, including loss of the [Eubacterium] brachy group.
CONCLUSIONS: RFX improved cognitive performance assessed by the Stroop test and reduced cirrhosis-related adverse events in patients with CHE. These randomized data support RFX as an effective therapeutic option and highlight the Stroop test as a sensitive endpoint for treatment response.
AIM: To evaluate the efficacy of rifaximin (RFX) as a treatment for CHE.
METHODS: In this multicentre, open-label randomized controlled trial, patients with CHE associated with liver cirrhosis were randomized (1:1) to receive RFX or no treatment and followed for 12 weeks. The primary endpoint was the change in Stroop test performance. Secondary endpoints included NCT-B scores, serum ammonia levels, cirrhosis-related adverse events, and gut microbiota composition.
RESULTS: Fifty patients were randomized and completed follow-up. Stroop test performance improved significantly in the RFX group (p = 0.006) but not in controls (p = 0.400), with a trend toward greater improvement with RFX (Δ Stroop test: -4.45 ± 7.12 vs. -0.98 ± 5.74 s; p = 0.056). Among patients not receiving synthetic disaccharides at baseline, improvement was significantly greater with RFX (Δ Stroop test: -3.73 ± 5.96 vs. -0.80 ± 5.86 s; p = 0.049). No significant changes were observed in NCT-B scores or serum ammonia levels. Cirrhosis-related adverse events were significantly reduced in the RFX group (p = 0.006). Overall, gut microbial diversity did not differ between groups; however, RFX selectively altered specific taxa, including loss of the [Eubacterium] brachy group.
CONCLUSIONS: RFX improved cognitive performance assessed by the Stroop test and reduced cirrhosis-related adverse events in patients with CHE. These randomized data support RFX as an effective therapeutic option and highlight the Stroop test as a sensitive endpoint for treatment response.