To the Editor Rahimi and colleagues1 should be congratulated on their trial. Hepatic encephalopathy is a costly, morbid condition, and they have advanced the current knowledge of its inpatient management.2 Timely resolution of altered sensorium is likely crucial for the prevention of nosocomial complications, containment of health care costs, and the return of patients with a debilitating condition to their functionality and a home discharge. Furthermore, these data seem to suggest that strictly osmotic laxatives are a preferable alternative for patients long displeased with nonabsorbable disaccharides such as lactulose. The implications of these findings for future research, however, should be evaluated in the context of the study design.
Tapper EB. Lactulose vs Polyethylene Glycol for Treatment of Hepatic Encephalopathy. JAMA Intern Med. 2015;175(5):867. doi:10.1001/jamainternmed.2015.0331