Comparison of efficacy of Rifaximin and Lactulose plus Zinc versus Rifaximin and lactulose alone in patients with hepatic encephalopathy at a tertiary care hospital.

Abstract

Objective: To compare the clinical efficacy of adjunctive zinc supplementation combined with standard lactulose and rifaximin therapy against lactulose and rifaximin alone in patients presenting with hepatic encephalopathy. Study Design: Analytical Cross-sectional Investigation. Setting: Department of Medicine, Sheikh Zayed Hospital, Rahim Yar Khan. Period: June to December 2025. Methods: One hundred eight adult patients diagnosed with hepatic encephalopathy (West Haven grades I–IV) were enrolled via consecutive sampling and allocated into two therapeutic arms. The intervention cohort received oral lactulose, rifaximin, and a zinc-carnosine formulation, whereas the control arm received standard dual therapy. Clinical efficacy was defined as a ≥1-grade improvement on the West Haven scale following seven days of continuous treatment. Data were analyzed using SPSS version 23.0, with Chi-square tests determining statistical significance. Results: Baseline demographic and clinical profiles were comparable between groups. Following the intervention period, 53.7% (n=29) of patients receiving zinc achieved substantial clinical improvement compared to 25.9% (n=14) in the standard therapy group (χ²=8.94, p=0.003). The calculated number needed to treat was 3.6. Both regimens exhibited comparable tolerability, reporting only mild gastrointestinal disturbances without serious adverse events. Conclusion: Supplementing conventional pharmacological management with zinc significantly accelerates short-term neurological recovery in hepatic encephalopathy. Integrating this affordable micronutrient adjunct into acute care protocols represents a highly effective strategy for optimizing clinical outcomes in cirrhotic populations.