Effect of poorly absorbable antibiotics on hepatic venous pressure gradient in cirrhosis: A systematic review and meta-analysis.

Mendoza, Yuly P.; Rodrigues, Susana G.; Bosch, Jaime; Berzigotti, Annalisa (2020). Effect of poorly absorbable antibiotics on hepatic venous pressure gradient in cirrhosis: A systematic review and meta-analysis. Digestive and liver disease, 52(9), pp. 958-965. Elsevier 10.1016/j.dld.2020.06.048

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BACKGROUND

The effects of poorly/non-absorbable antibiotics on hepatic venous pressure gradient (HVPG) are debated.

AIM

To analyze the effects of rifaximin or norfloxacin on HVPG and on markers of bacterial translocation and proinflammatory cytokines.

METHODS

We performed a systematic search of randomized clinical trials (RCTs) involving patients with cirrhosis and portal hypertension, assessing the effect of rifaximin or norfloxacin vs control on HVPG. Pooled analyses were based on random-effects models, heterogeneity was assessed by Cochran's Q, I2 statistic and subgroup analyses.

RESULTS

Five studies (215 patients) were included. Risk of bias was high in three. We found no significant differences using antibiotics versus control. The summary mean difference in HVPG was of -0.55 mmHg (95%CI:-1.52, 0.42; P = 0.27), with moderate heterogeneity (P = 0.15; I2 = 40%). RCTs with longer therapy (60-90 days) used non-selective-beta-blockers (NSBB) in both antibiotics and control arms. Subgroup analysis showed a significantly greater reduction in HVPG in the combination arm over controls (mean difference -1.46 mmHg [95%CI: -2.63, -0.28; P = 0.01]) with no heterogeneity (P = 0.46; I2 = 0%). Serum lipopolysaccharide-binding protein (LBP) significantly decreased with antibiotics, but with high heterogeneity (P < 0.001; I2 = 92%).

CONCLUSIONS

Rifaximin or norfloxacin did not significantly reduce HVPG in patients with cirrhosis and portal hypertension. Studies using antibiotic for longer periods on top of NSBB showed a significant decrease in HVPG.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Gastro-intestinal, Liver and Lung Disorders (DMLL) > Clinic of Visceral Surgery and Medicine > Hepatology
04 Faculty of Medicine > Department of Gastro-intestinal, Liver and Lung Disorders (DMLL) > Clinic of Visceral Surgery and Medicine
04 Faculty of Medicine > Pre-clinic Human Medicine > BioMedical Research (DBMR) > DBMR Forschung Mu35 > Forschungsgruppe Hepatologie
04 Faculty of Medicine > Pre-clinic Human Medicine > BioMedical Research (DBMR) > DBMR Forschung Mu35 > Forschungsgruppe Hepatologie

Graduate School:

Graduate School for Health Sciences (GHS)

UniBE Contributor:

Mendoza Jaimes, Yuly Paulin; Gomes Rodrigues, Susana; Bosch, Jaime and Berzigotti, Annalisa

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1590-8658

Publisher:

Elsevier

Language:

English

Submitter:

Yuly Paulin Mendoza Jaimes

Date Deposited:

03 Sep 2020 10:26

Last Modified:

03 Sep 2020 10:31

Publisher DOI:

10.1016/j.dld.2020.06.048

PubMed ID:

32736898

Uncontrolled Keywords:

Advanced chronic liver disease Antibiotics Hvpg Portal hypertension

BORIS DOI:

10.7892/boris.146156

URI:

https://boris.unibe.ch/id/eprint/146156

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