Letters Section Editor: Robert M. Golub,
MD, Senior Editor.
In Reply: We agree with Drs Piquet, Hourmand-Ollivier,
and Dao regarding the relationship between changes in intestinal flora following
oral treatment with poorly absorbable broad-spectrum antibiotics for the treatment
of hepatic encephalopathy and reduction in intestinal vitamin K absorption.
All of the participants in our study were in Child-Pugh class A; none had
had hepatic encephalopathy, and therefore none had received antibiotics or
synthetic disaccharides for this indication. No patients had been receiving
long-term antibiotic therapy for chronic respiratory tract infection or urinary
tract infection. Therefore, this mechanism for vitamin K deficiency is unlikely
to have played a role in our participants. Nevertheless, in patients with
more advanced hepatic cirrhosis than in our study, the opportunity of receiving
long-term antibiotic therapy is greater and may cause vitamin K deficiency.
Habu D, Shiomi S, Tanaka T, Nishiguchi S. Vitamin K Deficiency and Hepatocellular Carcinoma—Reply. JAMA. 2004;292(21):2580-2581. doi:10.1001/jama.292.21.2581-a